PRIVATE BUSINESS

London Local Authorities Bill [Lords]

Motion made,
	That the promoters of the London Local Authorities Bill [Lords] may, notwithstanding anything in the Standing Orders or practice of this House, proceed with the Bill in the present Session; and the Petition for the Bill shall be deemed to have been deposited and all Standing Orders applicable to it shall be deemed to have been complied with;
	That, if the Bill is brought from the Lords in the present Session, a declaration signed by the agent shall be deposited in the Private Bill Office, stating that the Bill is the same in every respect as the Bill brought from the Lords in the last Session;
	That the Clerk in the Private Bill Office shall lay upon the Table of the House a certificate, that such a declaration has been deposited;
	That in the present session the Bill shall be deemed to have passed through every stage through which it passed in the last Session, and shall be recorded in the Journal of the House as having passed those stages;
	That no further fees shall be charged to such stages.—[The Chairman of Ways and Means.]

Hon. Members: Object.
	To be considered on Wednesday 14 January.

Oral Answers to Questions

DEPUTY PRIME MINISTER

The Deputy Prime Minister was asked—

Social Housing Chief Executives

Brian Iddon: Which housing association or registered social landlord chief executive receives the highest remuneration; and how much they will receive in 2003–04.

Yvette Cooper: Figures for this year will be published in housing associations' annual accounts. Survey results for last year show that the average salary for the chief executives of the main RSLs was £88,000, but that the highest remuneration was £213,000 for the chief executive of Sanctuary. We are concerned that housing associations should not be promoting excessive and unjustifiable pay and severance packages, and my right hon. Friend the Deputy Prime Minister has written to the Housing Corporation to ask for further work on this issue.

Brian Iddon: I hope that my hon. Friend is aware that some former directors of housing are receiving considerable increases in salary, following stock transfer. I am aware of one who was earning about £70,000 as a director of housing, who is now earning double that figure—more than £140,000. Does my hon. Friend agree that, in the same way that some chief executives of private enterprises are now being held accountable to their shareholders, chief executives of housing associations should be held accountable by their tenants?

Yvette Cooper: My hon. Friend is right to suggest that RSLs need to justify chief executives' salaries to tenants, who are entitled to question some of the remuneration packages, and particularly some of the severance payments, that have been agreed. Taking those decisions is a matter for the RSL boards—housing associations are independent organisations—but there should be tenants on the boards and those tenants should be fully informed of the implications not simply for that RSL, but for the whole sector if irresponsible decisions are taken.

Nicholas Winterton: May I say from the Opposition Benches that I fully support the concern that has just been expressed by the hon. Member for Bolton, South-East (Dr. Iddon)? May I add that I am deeply concerned that many local authorities, district borough councils, are being forced—I use that word intentionally—to transfer their housing stock to social housing landlords, bearing in mind that many councillors and many, many tenants are opposed to that for the very sort of reason that the hon. Gentleman has expressed so clearly to the House? May we have further assurances from the Government that local authorities will not be forced to transfer because of the way that the Government are allocating resources?

Yvette Cooper: The hon. Gentleman is completely wrong. Local authorities are not being forced to do anything of the sort. The matter is up to a vote of local tenants, and that is as it should be. Local tenants should have the vote. Local tenants should have the say in what they think should happen to their local social housing because we must ensure that social housing is provided in the best interests of those tenants.

Ken Purchase: But is not the whole gambit of transferring stock bound to lead to the payment of inflated salaries to the very people who are currently administering our housing stock, who will be in charge of our rented housing stock in that new situation? Do we not already have in place the necessary checks and balances? Councillors are elected by council tenants and ratepayers, creating the checks and balances required to keep those things in order.

Yvette Cooper: My hon. Friend will know that there have been concerns about increases in the pay of local authority chief executives, on which my right hon. Friend the Deputy Prime Minister has expressed his views very clearly, so we must recognise that all sectors—whether the not-for-profit sector, the private sector or the public sector—need to exercise restraint and responsibility in setting pay settlements, and they certainly need to do so with senior salaries because they are the ones that set the example for the entire sector and that can have implications right across the sector. Particularly when we are talking about social housing, where the income comes from the rents of those who are on a low income, we must ensure that those services are provided in the interests of tenants, not of the providers.

Telecommunications Masts

Laurence Robertson: If he will introduce legislation to require public utilities to obtain planning permission before erecting masts; and if he will make a statement.

Keith Hill: In most cases, mobile phone operators' masts are subject to full planning permission or prior approval procedures. Other utilities have a range of so-called permitted development rights, which we are now reviewing as part of our planning reform agenda.

Laurence Robertson: I thank the Minister for that mildly encouraging response. In my constituency, Network Rail planned to build a 33 m mast in the village of Churchdown, but it withdrew its proposals when all the residents formed a group to oppose them. May I suggest that organisations such as Network Rail invest in investigating what alternative and, indeed, more advanced technology might be available to avoid siting masts where they are clearly not wanted and where they are clearly inappropriate? It might also be better if a formal consultation were required, so that residents had the right to prevent such things from happening in the first place.

Keith Hill: I am somewhat sympathetic to the points that the hon. Gentleman makes. He will be aware that there is a general height restriction of 15 m on water, gas and electricity undertakings, but there is no current restriction, as he says, on Network Rail. However, a report by the Lichfield consortium has been completed, which recommends similar restrictions on railway undertakers for mast installations in sensitive areas, so we are moving in that direction.

David Taylor: On the website of the Office of the Deputy Prime Minister, it says that the Government attach considerable importance to keeping the number of radio and telecoms masts and sites to a minimum. There seems to be some evidence that various telecoms companies are still developing their networks in parallel rather than sharing masts and sites. What are the Government doing that is tangible to minimise the number of such installations?

Keith Hill: If that is the case, my hon. Friend is absolutely right to say that that is not in the spirit of the undertaking made by the mobile phone operators. We expect them to synchronise and link together their masts. If there is evidence of the unreasonable proliferation of such masts, we will, of course, want to have a look at that. As a matter of principle I, as the Minister with responsibility for planning, have regular meetings with the mobile phone operators and I will certainly take up the matter with them when we next meet.

Crispin Blunt: From my experience in my constituency, I am absolutely convinced that Network Rail and its predecessors have been abusing their permitted development rights to gain a commercial advantage from the fact that they are able to put up such masts without planning permission. Will the Minister tell the House exactly when the Government will implement the welcome recommendations of the Lichfield consortium to limit Network Rail in the way in which other public utilities are limited?

Keith Hill: We intend to issue a consultation paper on the report produced by Nathaniel Lichfield and Partners, which I mentioned earlier, in the early summer of this year. We obviously want to take the representations of all interested parties into account before we contemplate possible legislation on the matter.

Geoffrey Clifton-Brown: I wish the Minister a happy new year and hope that he will make the correct decision on telephone masts. I am sure that he will be aware that Network Rail intends to put up several thousand masts. Many of the masts will be over 15 m and would normally require planning permission but will be exempt from that under the Town and Country Planning (General Permitted Development) Order 1995. Will he urgently review the matter, because Network Rail will put up the masts at a huge rate until the 1995 order is stopped?

Keith Hill: It is indeed 1995. I take the point that the hon. Gentleman makes. I recognise that there is extraordinary sensitivity in some circumstances about the proposed location of such masts and we will keep a close eye on the matter. In general terms, we have the matter very much under review.

Council Tax

Andrew MacKay: If he will make a statement on the level of council tax in 2003–04.

Nick Raynsford: In 2003–04 all councils had an above-inflation grant increase for the first time ever. Given this, we were very disappointed that local authorities chose to raise council tax so substantially with an average increase of 12.9 per cent. That trend in council tax rises is not sustainable and we have made it clear that we expect councils to budget prudently in the coming year with a view to council tax increases in low single figures. We have also made it clear that we will use our capping powers if local authorities persist in unreasonable council tax increases.

Andrew MacKay: What does the Minister say to my hard-pressed council tax payers in Bracknell who face a council tax increase next year that will be many times the level of inflation? Does he appreciate that even though an extra £700,000 has been granted as an additional payment because the Government realised that the passporting of money to schools was far too high, there will still be many other costs that Bracknell Forest borough council will have to meet? Those costs, which the Government force on the council, will not allow it to restrict its council tax increase to a modest amount. What is he going to do about that?

Nick Raynsford: I have spoken to the leader of the right hon. Gentleman's council, and made it clear that I expect it to budget prudently and introduce a modest council tax increase. That is entirely possible, because Bracknell Forest borough council has received a grant increase in the current year of 5.7 per cent., which is double the rate of inflation, and will receive in the coming year, following our provisional announcement, an increase of 7 per cent., which is three times the rate of inflation. We expect it to budget prudently.

Bill O'Brien: Does my right hon. Friend accept that the majority of local authorities appreciate the way in which the Government have helped local authorities with council tax and benefits? The formula that was recently introduced has helped local authorities considerably, and will he agree to continue to meet SIGOMA—the special interest group of municipal authorities, of which I am chairman in the House of Commons—to discuss further policies and progress on the formula? We do not want to return to the problems of the poll tax, which was introduced in the early days of the Tory Government.

Nick Raynsford: I thank my hon. Friend for his kind remarks about the grant distribution formula. I had an enjoyable visit to his local authority just before Christmas, and was impressed by the steps taken by the new management team and the leader of the council to ensure improved services for people in the area and, indeed, prudent budgeting. I assure him that there is absolutely no question that the Government will go back to the nonsense of the previous Government, particularly the poll tax.

David Curry: Whatever the size of this year's settlement, the Minister will be aware that the Government are still incapable of managing change competently. Is he aware that for many district councils the change in the method of paying rent allowance and council tax benefits, which is now done entirely by grant, and the removal of the population-based revenue support element mean that almost the entire increase in Government grant is swallowed up by the loss of revenue associated with those benefits? A council such as Harrogate will get the princely increase of 35p per inhabitant next year to cover all its additional costs. Does the right hon. Gentleman therefore accept that the safety net proposed by the Department for Work and Pensions is inadequate, and will he strengthen it before councils set their budget? Will he draw the lesson that, yet again, the Government cannot manage change and are simply incapable of joined-up government?

Nick Raynsford: That is somewhat rich coming from the right hon. Gentleman, whose Government had a remarkable record on change in local government finance. I need say no more but, on his specific point, the change from the current framework, whereby local authorities are reimbursed for costs incurred in paying council tax grant and housing benefit, is complex. There are two separate elements, but it is generally accepted that it is sensible to have a single element, and the reform is broadly welcomed by local government. The right hon. Gentleman understands these matters, so he will appreciate that any process of change involves transitional difficulties. The Department for Work and Pensions has proposed a transitional framework, which it is continuing to discuss. I hope that representations from his authority and other authorities with concerns will be taken into account—I am sure that they will.

David Curry: Last year, the Greater London authority precept was increased by 29 per cent. Given the strictures that the Minister has just repeated about the need to limit increases in council taxes and precepts, and given the fact that he has capping powers over precepts, what figure has he given Mr. Livingstone, his new party friend, for the maximum permitted increase in the GLA precept?

Nick Raynsford: We have told all local authority leaders, including the Mayor of London and the leaders of all London authorities, that we expect them to budget prudently and introduce increases in low single figures. As the right hon. Gentleman knows only too well, we have said that we will use our capping powers if necessary, and intend to do so if authorities are not responsible or prudent. That applies to all authorities, and I remind him that the largest increase in London last year was in the Conservative-controlled London borough of Wandsworth, which increased its council tax by a staggering 57 per cent.

Nick Palmer: Does my right hon. Friend accept that despite the help in the pre-Budget report, shire boroughs are still having some difficulty because of the changes in the formula? Does he also accept that much of the public resentment related to local government spending is linked to the fact that the council tax is not sufficiently progressive, and that widening the range of bands that councils can impose would be a useful step forward, which many councils would welcome?

Nick Raynsford: First, for the second year running, all district councils in the country are guaranteed an above-inflation grant increase. This is the first time that it has happened, and despite the concerns raised by my hon. Friend and by the right hon. Member for Skipton and Ripon (Mr. Curry) in relation to the transitional arrangements for support for housing and council tax benefit grant, I believe it will be possible for district councils to budget prudently. I am sure they will. Secondly, with regard to the wider issue—the banding system—this is one of the issues that we are considering in the context of the balance of funding review that is currently taking place.

Edward Davey: In the light of his answer to the right hon. Member for Skipton and Ripon (Mr. Curry), the Minister will know that the Deputy Prime Minister's newly rediscovered friend has published his draft budget, which proposes an increase of 12 per cent. in council tax band D for the GLA precept. Will that level be capped?

Nick Raynsford: I am sure the hon. Gentleman will recall his days on the Standing Committee of what became the Greater London Authority Act 1999, which created the Greater London authority. He knows that the budget is a complex process whereby the Mayor may propose a budget but it is subject to the approval of the assembly. The assembly has not yet discussed the Mayor's proposals. I am sure that its members will want to examine them very closely indeed, and I hope that they will ask searching questions about an increase that certainly does not meet our expectation of low single figures.

Antisocial Behaviour

Adrian Bailey: What steps his Department is taking to tackle antisocial behaviour.

Helen Southworth: What action his Department is taking to tackle antisocial behaviour.

John Prescott: My Office is tackling the root causes of antisocial behaviour though our sustainable communities plan, which will create thriving communities where people feel safe and want to live. We are also tackling the symptoms of antisocial behaviour by introducing a raft of measures in the Anti-social Behaviour Act 2003 and the Housing Bill, and through ongoing programmes such as that for neighbourhood wardens, with encouraging results.

Adrian Bailey: My local authority, Sandwell, is engaged in a consultation process to identify areas in the borough where public drinking is a nuisance. Given the importance of local authorities, the Government and the police working together to curb antisocial behaviour, can my right hon. Friend assure me that examples of local authority best practice will be promoted by the Government throughout the country?

John Prescott: Yes, I can give my hon. Friend that assurance. He will know that that is the responsibility of my right hon. Friend the Secretary of State for Culture, Media and Sport, and she is issuing guidance for parliamentary consideration, which we will consider in the House. It will bring about more uniform practice in respect of licensing and contribute to dealing with antisocial behaviour connected with drink.

Helen Southworth: Will my right hon. Friend monitor progress on the new local authority licensing powers, particularly the new responsibility that local authorities will have to order the temporary suspension of licences, so that pubs and clubs that allow under-age drinking, binge drinking and antisocial behaviour will get a swift penalty?

John Prescott: I certainly see the sense of that recommendation. Indeed, guidance from another Department will be issued shortly and the House will have to make a judgment as to whether it thinks that it is adequate. I shall pass on my hon. Friend's comments to my right hon. Friend the Secretary of State for Culture, Media and Sport.

Robert Key: Does the Deputy Prime Minister agree that one of the acts of antisocial behaviour that gravely disfigures our country, in every town and street, is the spitting and spreading of chewing-gum? I know that the Government have introduced some initiatives, but will the issue be covered by the Anti-social Behaviour Act 2003, as we really have to do something about chewing-gum?

John Prescott: There used to be a song about sticking chewing-gum on the bedpost at the end of the day. This is a very important issue, however. Anyone going into any of the regeneration areas can see the disfigurement caused by the casting away of chewing-gum. It is a deplorable practice—I know that it is controversial to say that—and we are looking at a number of measures that we can take to clear up the problem, which disfigures some very good developments and regeneration areas.

Shona McIsaac: Can my right hon. Friend tell me what his Department intends to do to persuade certain local authorities that are reluctant to use the new powers that they are about to be given in the Anti-social Behaviour Act 2003? What is his Department going to do to give them a kick up the rear end?

John Prescott: Well, I would not want to be associated with such violent action, but I think that we are making it very clear to local authorities what new powers in the legislation will allow them to do. Many authorities complain that they do not have the powers that they need or that they are not clear enough. The new Housing Bill and antisocial behaviour legislation will make an awful lot of improvements, and I expect all local authorities to play an important part. I do not know of any constituency in this country where people are not demanding that we deal with antisocial activity.

Roy Beggs: Is the Deputy Prime Minister sufficiently confident about the improvements that will be brought about by the new legislation on antisocial behaviour here in Great Britain to give an undertaking to us from Northern Ireland that his Government will seek to make the legislation available for use in Northern Ireland as quickly as possible?

John Prescott: I am convinced that the legislation will work. In fact, I think that there is a great deal of encouraging evidence about how such measures have affected antisocial areas in a number of countries. We think that the new framework will work. I am a little unsure about the last part of the hon. Gentleman's question and whether the measures apply to Northern Ireland. I take it from his indication that they do not do so, but he has raised an issue, I do not know the answer and I shall write to him about it. [Interruption.]

Mr. Speaker: Order. I call the House to order; it is far too noisy. [Hon. Members: "Hear, hear."] Perhaps those who are cheering me will agree to come to order.

Clive Betts: Does my right hon. Friend accept that in many areas, including my constituency, the police and local authorities are working together to use the new powers that they have been given? One of the problems, however, is that at the end of the process of eviction, tenants are all too often rehoused in another local authority house or end up in the private rented sector, where the landlords can be just as irresponsible as the tenants. Will he therefore give guidance to local authorities saying that we should not create a merry-go-round for antisocial tenants whereby they are simply moved from one property to another? There should also be a requirement for private landlords to assume wider responsibility for the antisocial behaviour of their tenants.

John Prescott: Security of tenure and the sanctions used need careful handling. The new Housing Bill that we will introduce to the House, I think on Monday next week, will cover some of the issues involved. However, this matter is not only about public housing and social landlords, but about licensing private landlords. We get a lot of difficulties in that regard, and we are now taking the powers to deal with the problem.

Council Performance Assessments

David Cameron: How much best value and comprehensive performance assessments have cost (a) district and (b) county councils in the last year; and if he will make a statement.

Phil Hope: We do not gather information about the costs incurred by local government on best value or comprehensive performance assessments. To do so would be an additional burden on local authorities.However, recent findings from independent research show that best value reviews are helping authorities to deliver improved services. The second year of comprehensive performance assessment results announced by the Audit Commission show real improvement in councils' performance.

David Cameron: Is the Minister aware that, in West Oxfordshire, best value and CPA have cost the council £600,000, the equivalent of £13 on a band D council tax bill? That compares with the £60 at which the authority set the total council tax—the second lowest level in the country. Does he agree that every council should find out the cost of these things and put them on the front of a council tax bill so that everyone can see how much they are paying for centrally imposed red tape and bureaucracy?

Phil Hope: I think that we have all seen the latest Tory list of meaningless platitudes about bureaucracy, and what people remember is the Tory record of Tory cuts—the Tory poll tax and Tory attacks on local councils. Oxfordshire has had an increase of 7.3 per cent. for next year, and we expect it to budget prudently and to keep its council tax down next year.

Ronnie Campbell: Has the Minister been informed that only this morning Northumberland county council in my area announced the closure of all its local authority old people's homes? Is that best value or Labour's best value?

Phil Hope: I understand my hon. Friend's concerns. It is important that local councils make a considered judgment about the way in which to provide the best services for local people. It is up to those authorities, in consultation with local people, to decide on the right way forward. If my hon. Friend has particular concerns about his constituency, I am happy to write to him about them. I can tell him, however, that local councils are providing better services to older people than they have ever had in previous generations, particularly under the Tories, who imposed cuts and compulsory competitive tendering on every council in the country.

PRIME MINISTER

The Prime Minister was asked—

Engagements

Ben Chapman: If he will list his official engagements for Wednesday 7 January.

Tony Blair: This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I will have further such meetings later today.

Ben Chapman: My right hon. Friend will be aware that unemployment in my constituency has gone down by 60 per cent. since 1997. That is, of course, good news, but it still means that 770 people are claiming jobseeker's allowance. Major manufacturing firms have suffered from problems such as the costs of doing business with the eurozone, the relative exchange rate during 2003 and increased costs in other areas, and we lost a major manufacturing plant—[Hon. Members: "Question!"] Can my right hon. Friend tell me what his plans are to ensure that small firms are allowed to trade unfettered and large manufacturing firms are allowed to prosper, so that Wirral, South can continue to be part of the strong economy during 2004?

Tony Blair: The best thing that we can do for small and large firms alike is to run the economy in a stable way. As my hon. Friend acknowledges, the fact that we have the lowest interest rates, lowest inflation and lowest unemployment for decades is good news for business, big and small alike. However, we still have a particular problem with those who are claiming jobseeker's allowance, and we want to see them back in work. My hon. Friend is right to say that there have been huge falls in unemployment in his constituency—and in other constituencies throughout the country—but the way that we will get those remaining people off the dole and into work is by continuing programmes such as the new deal for the unemployed, which has given opportunity to hundreds of thousands of people. That is why we will continue it, not abolish it, as the Conservative party would.

Michael Howard: rose—[Interruption.]

Mr. Speaker: Order. The House must come to order. I call the Leader of the Opposition.

Michael Howard: On 22 July, the Prime Minister was asked:
	"Did you authorise anyone in Downing Street or in the MOD to release David Kelly's name?"
	He replied:
	"Emphatically not. I did not authorise the leaking of the name of David Kelly."
	Does he stand by that statement today?

Tony Blair: I suggest first of all that the right hon. and learned Gentleman look at the totality of what I said, but I stand exactly by what I said then. However, the Hutton inquiry will look at all these issues and will make its report. I suggest to him and to Conservative Members that rather than trying to prejudge the report, they actually wait for it.

Michael Howard: We are not going to take any lectures from the Prime Minister on prejudging the inquiry. The statement that he made, and that I just put to him, was made after he set up that inquiry. He was also asked at that time:
	"Why did you authorise the naming of David Kelly?"
	He replied:
	"that is completely untrue."
	Does the Prime Minister also stand by that statement?

Tony Blair: I have already said, and I repeat, that the right hon. and learned Gentleman should consider the totality of my remarks. However, the inquiry will determine all those issues, and I suggest that he wait until the report is published to make his points. However, it is obvious from his questions today that the Conservative party has already made up its mind. Frankly, we know what Conservative Members will say, whatever the report says.

Michael Howard: The Prime Minister did not answer the question, as the whole country will see, so let me give him another opportunity. He was asked:
	"Why did you authorise the naming of David Kelly?"
	He replied:
	"that is completely untrue."
	Does the Prime Minister stand by that statement?

Tony Blair: I have already made it clear in answer to the right hon. and learned Gentleman's first question that I stand by the totality of what I said, but in relation to the issues that he raises, and all the others, the Hutton inquiry will report shortly and I suggest that he wait for that. It is obvious from comments that he and his colleagues have made in the past few days that it does not matter what the inquiry concludes; he has already made up his mind. However, I suggest that the rest of the House wait for the report.

Michael Howard: But the permanent secretary at the Ministry of Defence has said that the decision to authorise the disclosure of Dr. Kelly's name was taken at a meeting chaired by the Prime Minister. Is not it clear that either the permanent secretary or the Prime Minister is not telling the truth?

Tony Blair: No, it is not—as I believe that we will show when the inquiry report is published. Rather than our having a debate about the evidence now, which strikes me as rather absurd, given that we are about to have the report published, and rather than the right hon. and learned Gentleman cross-examining me now, he can do that on the day the report is published—according to what it says, not according to what he says.

Michael Howard: I can assure the Prime Minister that I am looking forward to that.
	The Prime Minister has said that Ministers in a Government that he leads should resign if they lie to Parliament. Does that apply to the Prime Minister?

Tony Blair: Of course it applies to me, as it applies to all Ministers. However, since we are about to have a report that will decide whether people have or have not lied to Parliament, is it not sensible to wait for it rather than having an absurd preliminary now? As for the right hon. and learned Gentleman's relish in examining me on the report, it is equalled by mine in rebutting some of the rubbish that he has been saying in the past few weeks.

Anne Picking: Is my right hon. Friend aware that the Accommodation and Works Committee has asked the equivalent Committee in the other place to reconsider where to put the statue of Sylvia Pankhurst? Although I understand that that is a House matter, does he agree that Sylvia Pankhurst did wonderful things to help the struggles of working-class women? As we honour men who run about a field kicking balls, can we not commemorate someone who had some?

Tony Blair: I am looking for the Sylvia Pankhurst brief, but it does not appear to be with me. We have nothing against men kicking balls around a field—we are completely in favour of them, especially when they win the world cup for England.

Patrick McLoughlin: That was rugby.

Tony Blair: The hon. Gentleman might have noticed that they kick the ball on the rugby field as well. Anything that happens to a statue of Sylvia Pankhurst is a matter for the House. Obviously, I should like her to be honoured; she was a tremendous champion of women's rights and women's suffrage—but the details should not be for me but for the House authorities.

Charles Kennedy: Does the Prime Minister anticipate that Labour's endorsement of Ken Livingstone as candidate for London Mayor will prove more successful than Ken Livingstone's endorsement of Labour during the Brent, East by-election?

Tony Blair: The electorate will decide that, and we look forward to joining battle with the right hon. Gentleman and his candidate in the election.

Charles Kennedy: Is not the fact of the matter that yesterday's dodgy deal between the two of them means that, together, they have sold their souls? We all know that Ken Livingstone disagrees with the Prime Minister on everything from the London tube to top-up fees to Iraq. They are united in their mutual complete and utter chicanery, and the voters are going to see through that.

Tony Blair: Talking of chicanery, I thought that at our first Prime Minister's questions after we came back after the recess, we were going to have a discussion about the right hon. Gentleman's spending plans. It is a pity that we are not going to do so, because I have quite a lot to say on the subject. I will say it the next time he asks me about it, because there have been a few interesting developments. As for the mayoral election, we shall all have our candidates, we shall fight the election, and let us see who wins.

Jim Sheridan: This Government have made good progress on introducing effective employment legislation, particularly with the introduction of the national minimum wage, which was either opposed by or lacked the support of some of the Opposition parties. Will my right hon. Friend continue the good work by extending the provisions and the principle of the national minimum wage to many of the youngsters in our communities who are currently excluded from it, and are therefore subject to potential exploitation by unscrupulous employers?

Tony Blair: We await a report from the Low Pay Commission on the possibility of extending the national minimum wage to 16 and 17-year-olds. I know that my hon. Friend would accept that the introduction of the minimum wage has benefited about 1.3 million workers to an enormous extent. It is worth pointing out that all those people who warned that its introduction would damage British jobs and competitiveness have been comprehensively proved wrong. However, the reason why we did not initially introduce it for 16 and 17-year-olds was that we feared that it might have an impact on youth unemployment. We need to examine that idea carefully again in the light of what the Low Pay Commission recommends. We will study those recommendations very carefully. As ever, we must strike a balance between what we want to do to improve people's living standards, and ensuring that we do not harm job prospects.

Bill Wiggin: "A person who calls for"—
	the Chancellor—
	"to be sacked and whose economic politics do not stand up has a total disregard for sensible, mature politics."
	That is what the Prime Minister said about Ken Livingstone four years ago, when he used to denounce people who called for the Chancellor to be sacked. Why has he chosen to support them now?

Tony Blair: Let me give the hon. Gentleman an example of why I think it is important that we back the policies of the London Mayor in relation to London. Those policies include a commitment to increase the number of police officers. The number of police officers in London has risen to record levels—there are now 3,000 more of them—and some of us remember who was Home Secretary when police numbers in London were actually cut.

Shona McIsaac: The industries on the Humber bank represent one of Britain's major manufacturing areas, but is my right hon. Friend aware that 475 jobs were lost in the Grimsby area in the last year? What are the Government going to do to assist areas such as Grimsby and Cleethorpes to help to regenerate them and to encourage manufacturing, particularly in view of our peripheral geography?

Tony Blair: There are three things that we can do to help those seaside towns. As my hon. Friend acknowledges, unemployment has fallen in those areas, but we still have some distance to go. The first thing is to use the neighbourhood renewal fund; the second is to use European Union structural funds; the third is to ensure that we get the right resources from the new deal for the unemployed into seaside towns where there are pockets of endemic unemployment. It is in part as a result of doing those things that the long-term unemployment in my hon. Friend's constituency has fallen by more than 90 per cent. I believe that if we continue with the policies of sound economic management and the new deal for the unemployed, we will reduce the numbers of unemployed still further.

Richard Shepherd: Surely it is not the responsibility of Lord Hutton to reconcile the Prime Minister's statements on the release of the name of Dr. Kelly. Surely it is the duty of the Prime Minister to reconcile his statements on this matter, which comes within his responsibility both to the House and to the country.

Tony Blair: Of course it is, but what I am saying to the hon. Gentleman and the Conservative party is, let us wait and deal with these issues in the light of the Hutton report, which will make the specific findings on all these questions. Surely it is more important to debate those issues on the basis of what the report actually says, rather than on the basis of speculation as to what it might say.

Valerie Davey: Does my right hon. Friend consider that the case for action by the coalition in defence of human rights would be strengthened if justice were seen to be done for all 660 detainees at Guantanamo Bay?

Tony Blair: I agree that it is important. Talks are continuing on the issue. Not much has happened over the Christmas period, for obvious reasons, but I hope that we will shortly be able to tell the House how the issue will be handled, particularly in relation to the British detainees at Guantanamo Bay. I return to the point that I have made on many occasions, however, which is particularly important to emphasise when there is still, rightly, a lot of concern about possible terrorist activity: some of the information that we have had from those detained at Guantanamo Bay has been of immense importance.

Patrick Cormack: As the Prime Minister has rightly indicated that he wants to do everything possible to help the police in their battle against rural crime, will he give the House an undertaking today that he will do nothing this year to criminalise the activities of one of the most law-abiding sections of the rural community?

Tony Blair: If the hon. Gentleman is referring to the hunting issue, it is, as I have said previously, subject to a free vote, and a matter for the House.

Phil Sawford: In the pre-Budget statement, the Chancellor announced additional funding for local authorities. Obviously, local authorities in my Kettering constituency, which were systematically underfunded by the previous Government, welcome that additional money. Police authorities, however, were not given any additional funds. Will my right hon. Friend look at funding for police authorities to ensure that they receive funding in line with the formula in future years?

Tony Blair: I know that this is an issue for my hon. Friend, and he has made many representations on it. Northamptonshire, like other police authorities, was given a significant increase in funding. We are looking all the time at what more we can do, however. I simply point out that we now have record numbers of police officers in this country: I think that we have in the region of 9,000 more police officers than we had in 1997. It is important that we recognise that that is also now being boosted by thousands of community support officers. The Conservative party opposed both the investment in record numbers of police and the community support officers.

Patsy Calton: Can the Prime Minister tell us whether he is content to preside over a country in which the results of post office consultations on closure are ignored 99 times out of 100?

Tony Blair: As I have said previously on this issue, a steady stream of post office closures has occurred for a number of years. We are putting several hundred million pounds into supporting rural post offices. As a result, significant support has been given to those post offices. It lies on the shoulders of anyone who says that they would prevent any post office closures to say how they could fund such a thing. If we were to give that commitment, it would run into hundreds of millions of pounds, and we cannot afford to make it.

Andy King: When the aviation White Paper was published last month, the people of Coventry and Warwickshire in particular heaved a huge sigh of relief. The peace of the people in my constituency and in neighbouring constituencies, however, is about to be shattered by the irresponsible behaviour of Coventry airport, which has done a shabby deal with Thomsonfly without any consultation, and without any regard for safety or for the implications of night flying for its neighbours. Will my right hon. Friend do everything that he can to ensure that any changes in Coventry are well within the constraints of the White Paper?

Tony Blair: Let me say first that I was not aware of the specific issue raised by my hon. Friend. He will know that we do not support the option of a new airport between Coventry and Rugby. We have published a comprehensive White Paper, and I can assure him that we will make sure that any developments that occur are within the proper principles and guidelines set out in that White Paper. Certainly, I shall examine the issue that he has raised.

Vincent Cable: As the Prime Minister confirmed on Monday that British troops will be in Iraq for at least two more years, can he confirm the estimate that by that time, the cost to the British taxpayer of occupation and reconstruction will be at least £7 billion? In view of the vast costs involved, what success has he had in persuading friendly countries to defer the costs that the UK incurred in the first Gulf war?

Tony Blair: I would not confirm the figure that the hon. Gentleman has just given—and as for what commitment we make to Iraq in terms of troops in years to come, I simply cannot be sure of that. Again, contrary to some reports, I have not said that thousands of British troops will be there for years. I do not know at this time, but what I do know is that the reconstruction of Iraq is important not just for that country, but for the stability of the region and of the wider world. Some 30 countries are helping us in Iraq at the moment—it is not just the US and the UK—and I think it very important that we make sure that that reconstruction succeeds. What it will cost at this stage we cannot say, but I do believe that it is an investment in the future stability and security of that region and of the world, and I welcome it.

David Stewart: Does my right hon. Friend share my view that the joint strike fighter will provide tremendous improvement in the capability of the Royal Air Force, and does he accept that, for British manufacturing to be able to upgrade and improve the JSF, we need technological transfer from the United States? What steps does he plan to take in order to gain that technological transfer from the US Government?

Tony Blair: My hon. Friend's point is very important, because participation in the joint strike fighter programme will mean that we guarantee, and expand on, thousands of jobs in the UK. At the moment we are working with the US in respect of the technology. That technology will have applications that go beyond the JSF programme, so it is important that we make sure that we get the right access to it. The discussions with the US are going well, and I very much hope that they will have a positive result.
	People sometimes ask what are the benefits, apart from security, of this country's relationship with the United States. We should recognise that in terms of defence co-operation, for example, which has a spin-off into all sorts of areas, our alliance with the US is of enormous importance, not least to British industry.

Henry Bellingham: Does the Prime Minister recall that five years ago, he promised to crack down on school truancy to help end social exclusion? Is he aware that despite a 700 per cent. increase in spending on anti-truancy schemes, truancy has gone up by a staggering 40 per cent.? Is this not yet one more example of his Government increasing public expenditure but totally failing to deliver any improvements?

Tony Blair: No, it is not, because the figures that the hon. Gentleman gives are wrong. The number of children in school has increased significantly, so that has to be taken into account when assessing the percentage levels of truancy. Those levels are at their lowest, and school attendance is at its highest level. I can assure him about what would happen if we were not making this investment. For example, a lot of this money is being spent on pupil referral units. That is contrary to the position that we found when we took office, whereby pupils excluded from school were getting a couple of hours' schooling a week, and were otherwise simply roaming the streets. As a result of that extra money, such pupils are now in full-time lessons five days a week, actually being taught something. That is where the money is going, and it is money well spent.

Ian Gibson: My right hon. Friend will be aware that a very innovative exercise has been carried out called "GM nation", through which the public were asked for the first time ever on a widespread basis about their views on genetically modified food. What difference might that exercise make to Government policy on GM foods?

Tony Blair: It gives us the opportunity to discriminate between various different types of GM technology, and it allows us to say that in certain circumstances there may be reasons—because of problems of biodiversity, for example—why we would not want to develop certain GM foods. On the other hand, in respect of certain crops it may be in our interests to do so. In terms of GM, it is also important—[Interruption.] Contrary to the Conservative party, I happen to believe it important that these measures be dealt with on the basis of science, because the biotech industry is of huge importance to this country. GM technology has a huge application not just in relation to food, but particularly in relation to medicine. Yes, it is vital that we proceed by public consultation, but also on the basis of the evidence about the science of GM, because its potential is enormous for the future of our country and of the world.

Peter Tapsell: Is the Prime Minister still able to remember that he led this country into war with the specific and categoric statement that in the spring of last year, Iraq possessed weapons of mass destruction that threatened Britain? As it is now becoming increasingly clear that that statement was a conspiratorial pretext for the war, why does he believe that it is honourable for him to continue in office?

Tony Blair: Because I believe that it is absolutely clear that Saddam Hussein both developed and used weapons of mass destruction. We put the information to the House on the basis of the intelligence that we received. Incidentally, I still believe that that intelligence was correct and I believe that, had I ignored that intelligence and decided not to take action in respect of the threat that was perceived, I would have been failing in my duty to this country. I would also point out to Opposition Members that it should be possible to have a debate about the rights and wrongs of the conflict in Iraq—I happen to believe passionately that it was the right thing to do—without attempting to attack each other's integrity.

Nigel Beard: Will my right hon. Friend consider making an appeal to all universities and research laboratories to ensure that where work relates to public health and welfare, it is properly reviewed by peers working in the same field? Does he agree that if that had been done in respect of the work of Dr. Wakefield, which purported to link the MMR vaccine to autism but was never corroborated, a great deal of parental anxiety and a dangerous reduction in child vaccinations could have been avoided?

Tony Blair: My hon. Friend is right to suggest that the controversy over MMR is a good example of people's fears being raised quite unnecessarily, because the evidence is very clear. He will know that my right hon. Friend the Secretary of State for Education and Skills has certain proposals about changing research funding, to which I refer my hon. Friend. I agree that it is important for funding to be awarded on the basis of good scientific research.

Nick Gibb: Who determines education policy in this country—the profession or Ministers? The Labour manifesto of 1997 promised more setting in schools, but in a parliamentary answer to me last year, the Prime Minister said that that was a matter for heads and teachers. If he believes that setting is right, and given that parents want it and that it appeared in the manifesto, why do 62 per cent. of lessons in comprehensive schools today take place in mixed-ability classes?

Tony Blair: I am not sure about the figure that the hon. Gentleman gave, and I would like to check it before accepting it. However, there is a balance to be struck between the Government saying that setting is something that we want to encourage in the right circumstances, and specifically telling schools that they have to operate in a specific way. Surely it is the case that setting in schools should be done where it is appropriate, but we do not believe that it is right for the central Government to dictate to schools and say that setting has to be done in all circumstances. I would point out, however, that the majority of comprehensive schools that I know about do engage in setting where they think it appropriate.

David Winnick: Should the Government not act on an issue in respect of which the vast majority of Labour MPs and people in the country agree—that hunting with dogs should be banned, that the Parliament Act should be used and that on that matter, the Lords majority should be told where to get off? I suggest that the Prime Minister act on the issue, because it is right to end that barbaric sport once and for all.

Tony Blair: As I have said before, we are committed to resolving the issue in this Parliament and we will do so.

Matthew Green: Does the Prime Minister envisage any circumstances in which his Government would scrap council tax and introduce local income tax?

Tony Blair: It is not our policy to scrap council tax and introduce local income tax. I have to say to the hon. Gentleman and the Lib Dems that whatever system of taxation is introduced, the money still has to be raised. I personally think that it would be difficult to persuade people of the wisdom of allowing local authorities to tax people's income.

Michael Connarty: The Prime Minister will be aware that the European Parliament has rejected a proposal from the European Commission to put value added tax on postal services. However, the matter can be referred back to the Commission and then brought forward to the Council of Ministers. Can we have an assurance that the Government will oppose the imposition of VAT on postal services, as that, of course, would cause Royal Mail prices to rise?

Tony Blair: The promises that we have made on VAT, and other promises, will of course be kept.

Iris Robinson: Will the Prime Minister involve himself urgently and personally in resolving the very real concerns felt by Northern Ireland prison officers in response to the threats made to them and their homes? Will he ensure that all necessary security is provided, thus avoiding threatened strike action across the UK?

Tony Blair: Obviously, we are looking at the concerns of prison officers in Northern Ireland, and at what we can do to ensure that they are given proper protection. It is obviously to their advantage, and to the advantage of other people, that a more peaceful situation be brought about in Northern Ireland. However, I know that the dispute is at present subject to discussions between the officers' union and the Northern Ireland Office. If the hon. Lady will forgive me, I think that I will leave them to take those discussions further.

BILLS PRESENTED

Civil Contingencies

Mr. Douglas Alexander, supported by Mr. Chancellor of the Exchequer, Mr. Secretary Blunkett, Mr. Secretary Murphy, Mr. Peter Hain, Mr. Adam Ingram and Mr. John Hutton, presented a Bill to make provision about civil contingencies: And the same was read the First time; and ordered to be read a Second time tomorrow, and to be printed. Explanatory notes to be printed. [Bill 14].

Sustainable and Secure Buildings

Mr. Andrew Stunell, supported by Sir Sydney Chapman, Sir Nicholas Winterton, Alan Simpson, Joan Walley, Brian White, Mr. Simon Thomas, Sue Doughty, Mrs. Patsy Calton, Mr. Peter Ainsworth, Paddy Tipping and Mr. David Amess, presented a Bill to make provision in relation to matters connected with buildings: And the same was read the First time; and ordered to be read a Second time on Friday 30 January, and to be printed. [Bill 15].

Carers (Equal Opportunities)

Dr. Hywel Francis, supported by Tony Baldry, Mr. Roy Beggs, Mr. Roger Berry, Mr. Paul Burstow, Mr. Tom Clarke, Mr. Huw Edwards, Mr. David Hinchliffe, Anne Picking, David Taylor, Mrs. Betty Williams and Hywel Williams, presented a Bill to make provision about life-long learning for, and the employment of, carers; to place duties on local authorities and health bodies in respect of carers; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 6 February, and to be printed. [Bill 16].

Gangmasters (Licensing)

Jim Sheridan, supported by Mr. John Lyons, Anne Picking, Mr. Mark Simmonds, David Hamilton, Mr. Iain Luke and Mr. John MacDougall, presented a Bill to make provision for the licensing of gangmasters; to make further provision concerning the enforcement of legislation relating to gangmasters; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 27 February, and to be printed. [Bill 17].

Promotion Of Volunteering

Mr. Julian Brazier, supported by Mr. Iain Duncan Smith, Mr. Bruce George, Mr. Chris Smith, Mr. Tim Boswell, Mr. John Burnett, Mrs. Gwyneth Dunwoody, Mr. Nick Hawkins, Charles Hendry, Mr. Jimmy Hood, Mr. Lindsay Hoyle and Mr. Ian Taylor, presented a Bill to make provision for volunteering and voluntary organisations; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 5 March, and to be printed. [Bill 18].

Cardiac Risk in the Young (Screening)

Ms Dari Taylor, supported by Jim Dobbin, Mr. Kevan Jones, Shona McIsaac, Mr. David Drew, Ms Meg Munn, Andy Burnham, Jean Corston, Dr. Julian Lewis, Mr. Eric Pickles, Dr. Vincent Cable and Mr. Nigel Jones, presented a Bill to make provision about screening for conditions leading to sudden cardiac death in the young; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 12 March, and to be printed. [Bill 19].

Christmas Day (Trading)

Mr. Kevan Jones, supported by Mr. A.J. Beith, Ann Coffey, Sir Patrick Cormack, Mr. David Crausby, Mrs. Gwyneth Dunwoody, Mr. Gerald Howarth, Helen Jones, Mr. Colin Pickthall, Mark Tami, Mr. Tom Watson and Sir Nicholas Winterton, presented a Bill to prohibit the opening of large shops on Christmas day: And the same was read the First time; and ordered to be read a Second time on Friday 26 March, and to be printed. [Bill 20].

Protective Headgear for Young Cyclists

Mr. Eric Martlew, supported by Mr. Julian Brazier, Mr. David Rendel, Dr. Richard Taylor, Mr. Keith Bradley, Mr. Andrew Mitchell, Dr. Howard Stoate, Mr. Joe Benton, Mr. Hilton Dawson, Mr. Mike Hancock, Keith Vaz and Annabelle Ewing, presented a Bill to make provision for the wearing of protective headgear by children while riding cycles; to prescribe offences and penalties; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 23 April, and to be printed. [Bill 21].

Constitution for the European Union (Referendum)

Mr. John Maples, supported by Mr. Frank Field, Mr. David Heathcoat-Amory, Kate Hoey, Mr. Peter Lilley, Mr. Archie Norman, Mr. George Osborne, Richard Ottaway, Sir George Young, Mr. Edward Garnier, Mr. Andrew Tyrie and Mrs. Gillian Shephard, presented a Bill to make provision for a referendum on any Treaty establishing a Constitution for the European Union; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 23 April, and to be printed. [Bill 22].

Retirement Income Reform

Mr. Adrian Flook, supported by Sir John Butterfill, Mr. David Curry, Mr. Frank Field, Mr. Edward Garnier, Steve Webb and Mr. Andrew Lansley, presented a Bill to amend the law relating to the provision of retirement income in respect of private and personal pensions, annuities and defined and additional voluntary contribution pension schemes: And the same was read the First time; and ordered to be read a Second time on Friday 26 March, and to be printed. [Bill 23].

Referendums (Thresholds)

Mr. Gordon Prentice, supported by Mr. Graham Stringer, Geraldine Smith, Mr. Lindsay Hoyle, Mr. Ian Liddell-Grainger, Mr. Nigel Evans, Mr. George Howarth and Bob Russell, presented a Bill to amend the Political Parties, Elections and Referendums Act 2000 to make provision to set thresholds in respect of referendums; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 27 February, and to be printed. [Bill 24].

Town and Country Planning (Enforcement Notices and Stop Notices)

Mr. John Randall, on behalf of Mr. Eric Pickles, supported by Mr. Philip Hammond, Mr. Geoffrey Clifton-Brown, Mr. John Hayes, Mr. Robert Syms, Mr. John Randall and Mr. Mark Field, presented a Bill to amend the Town and Country Planning Act 1990 in respect of enforcement notices and stop notices; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 5 March, and to be printed. [Bill 25].

Wild Mammals (Protection) (Amendment) (No. 2)

Mr. Peter Luff, on behalf of Lembit Öpik, supported by Kate Hoey, Mrs. Gwyneth Dunwoody, Mr. Austin Mitchell, Mr. Barry Sheerman, Mr. Peter Luff, Richard Ottaway, Mr. James Gray, Mr. Andrew Mitchell, Mr. Roger Williams, Mr. Paul Tyler and Mr. Simon Thomas, presented a Bill to amend the Wild Mammals (Protection) Act 1996: And the same was read the First time; and ordered to be read a Second time on Friday 6 February, and to be printed. [Bill 26].

Performance of Companies and Government Departments (Reporting)

Andy King, supported by Linda Perham, Mr. Michael Meacher, Mr. Martin O'Neill, Mr. John McFall, Mr. Barry Sheerman, Tony Baldry, Sue Doughty, Norman Baker, Mr. Simon Thomas, Mr. Andrew Dismore and Mr. John Horam, presented a Bill to make provision for the production and publication of annual reports on the social, environmental and economic impacts and performance of companies and Government departments; to specify certain duties of directors and Ministers; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 30 January, and to be printed. [Bill 27].

Property Repairs (Prohibition of Cold-Calling)

Mr. Andrew Robathan, supported by Mr. Paul Truswell, Dr. Julian Lewis, Ann Clywd, Sir Sydney Chapman, Ann Keen and Mr. James Paice, presented a Bill to make provision about cold-calling to solicit employment to undertake the laying of drives and other property repairs, maintenance and improvements: And the same was read the First time; and ordered to be read a Second time on Friday 12 March, and to be printed. [Bill 28].

Illegal Hare-Coursing (Enforcement of Prohibition)

Hugh Robertson presented a Bill to make provision for the enforcement of the prohibition on illegal hare-coursing: And the same was read the First time; and ordered to be read a Second time on Friday 12 March, and to be printed. [Bill 29].

Highways (Obstruction by Body Corporate)

Mr. Michael Jabez Foster, supported by Dr. Desmond Turner, Norman Baker, Laura Moffatt and Mr. David Lepper, presented a Bill to apply section 314 of the Highways Act 1980 to offences under sections 137 and 137ZA of that Act: And the same was read the First time; and ordered to be read a Second time on Friday 6 February, and to be printed. [Bill 30].

Genetically Modified Organisms

Gregory Barker, supported by Mr. William Hague, Mr. Peter Ainsworth, Mr. John Hayes, Mr. David Cameron, Tony Baldry, Mr. Jonathan Sayeed, Mr. Michael Meacher, Joan Ruddock, Alan Simpson, Sue Doughty and Mr. Simon Thomas, presented a Bill to establish a licensing regime in the event of the release of genetically modified organisms into the environment; to establish liability for the release of genetically modified organisms into the environment and for damage caused thereby; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 26 March, and to be printed. [Bill 31].

Town and Country Planning (Telecommunications Masts)

Mr. Richard Spring, supported by Mr. Gary Streeter, Mr. Hugo Swire, Mrs. Marion Roe, Mr. Gerald Howarth and Mr. Keith Simpson, presented a Bill to amend the law relating to telecommunications masts: And the same was read the First time; and ordered to be read a Second time on Friday 5 March, and to be printed. [Bill 32].

Trespassers on Land (Liability for Damage and Eviction)

Mr. Gerald Howarth, supported by Mr. Philip Hammond, Dr. Julian Lewis, Mr. Mark Todd, Mr. Crispin Blunt, Mr. Nick Hawkins, Mr. Graham Allen, Mr. Humfrey Malins, Mr. James Arbuthnot and Sir George Young, presented a Bill to make a person liable for any damage caused to land, or property on that land, on which he is trespassing for the purpose of residing there; to amend the law in respect of eviction from land; to make provision for compensation; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 5 March, and to be printed. [Bill 33].

Older People's Commissioners

Ian Lucas, supported by David Taylor, Mr. John Horam, Mr. Paul Tyler, Mr. Parmjit Dhanda, Mr. Roger Williams, Ms Joan Walley, Mr. Nigel Evans, Albert Owen and Gareth Thomas, presented a Bill to establish Older People's Commissioners for England and Wales; to make provision for the Commissioners' duties in respect of the protection of the rights and interests of older people; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 23 April, and to be printed. [Bill 34]. Opposition Day

[1st Allotted Day]

NHS Performance Indicators

Mr. Speaker: I inform the House that I have selected the amendment in the name of the Prime Minister.

Tim Yeo: I beg to move,
	That this House calls for an inquiry into the circumstances surrounding the decision in July 2002 to upgrade the star rating of the South Durham Health Care Trust from two stars to three following the involvement of the private office of the then Secretary of State for Health and with the knowledge of 10 Downing Street; further calls for greater transparency in the calculation and publication of performance indicators throughout the NHS; and is concerned that excessive reliance on such indicators inhibits the independence of professionals and managers and leads to distortions in the allocation of resources.
	I draw the attention of the House to my entry in the Register of Members' Interests.
	I am delighted that on its third day back at work the House has the chance to debate the circumstances surrounding the award in July 2002 of three stars to the South Durham Health Care NHS trust. We are indebted to the Health Service Journal for exposing those circumstances in a report published on 18 December, the day the House rose for the Christmas recess. The Health Service Journal revealed facts that raise serious questions about the integrity of the way in which the star rating system was operated in 2002, about the extent of ministerial interference in the award of stars to individual trusts and about the involvement of Downing street in that process.
	Let us examine the sequence of events. On 12 July 2002 the head of the performance development unit at the Department of Health, Mr. Giles Wilmore, sent a paper to the then Secretary of State, the right hon. Member for Darlington (Mr. Milburn), to whom I wrote last night to warn him that I would be mentioning him by name in today's debate. That paper explained that the methodology for calculating the 2002 star ratings had been agreed with the Commission for Health Improvement and that the inspectorate's assessment had been incorporated into the results, for which the Department was fully and solely responsible. The paper also explained that the results had been checked with the four directorates of health and social care.
	The list of star ratings was attached to the paper, showing an increase in the number of hospitals receiving three stars compared with the 2001 awards. Mr. Wilmore explained that despite the overall increase in performance
	"there are still a few high-profile trusts which we might have expected to be three stars which are not."
	His next comment, according to the report in the Health Service Journal, is significant and I shall quote it in full:
	"Unfortunately, even if time allowed it, further revisions to the methodology to promote these trusts would inevitably lead to other individual results we have not expected, as well as making the scoring system more complicated."
	In the view of Mr. Wilmore, tinkering with the basis for calculating star ratings at such a late stage would be undesirable.
	The then Secretary of State disagreed. Three days later, on 15 July, his private office, in the shape of Sammy Sinclair, warned Mr. Wilmore in an e-mail that the Secretary of State wanted to reconsider the issue. The Secretary of State was apparently very unhappy about the rating given to the Northumbria health care trust and asked whether it could be
	"urgently revisited with the Commission for Health Improvement."
	The same e-mail from the Secretary of State's office went on:
	"The Secretary of State would also identify South Durham as a high-profile trust given that it serves the Prime Minister's constituency. Why has it fallen from three stars last year to two stars?"
	The e-mail no doubt anticipated the questions that the Prime Minister was likely to put and it had the desired effect. The very next day, on 16 July, a new paper arrived from Mr. Wilmore, confirming that the star ratings had been recalculated. That paper stated:
	"Alterations to the methodology have been made resulting in the changes to individual trusts that were requested."
	There can be no doubt about what was going on. That senior official received a request from the Secretary of State to make changes to the rating of the NHS trust that serves the Prime Minister's constituency. As it happened, it also served part of the Secretary of State's constituency. Imagine the relief in his office that day as his staff scanned the latest document to find that no fewer than seven more NHS trusts had now received the coveted three stars, and those seven included the all-important South Durham health care trust.
	The Secretary of State had prevailed. He had found a way—no matter at what cost in terms of lost integrity—to manipulate the ratings. There is no indication that the changes had the approval of the Commission for Health Improvement or even that it was consulted. Mr. Wilmore's latest note contained a warning, however. It said that changing the results in the way described
	"makes the scoring methodology more difficult to explain and less transparent."

Adrian Bailey: There is nothing new in the hon. Gentleman's allegation. It has been made a number of times and repudiated to the satisfaction of pretty much everyone except the Conservatives. As he is concerned about the integrity of the process and the abuse of ministerial position, I draw his attention to a real case of ministerial abuse, as outlined by his Front-Bench colleague, the hon. Member for West Chelmsford (Mr. Burns), in the Standing Committee on the Health and Social Care Bill on 18 January 2001—

Mr. Speaker: Order. Interventions are usually short. The hon. Gentleman is making a speech.

Tim Yeo: That was a pretty disgraceful performance by the hon. Member for West Bromwich, West (Mr. Bailey). I hope that other interventions will address the subject matter of the debate.
	Given that the formula for calculating star ratings in 2002 had just five elements and that for one of those five—clinical focus—South Durham's performance for emergency readmissions for adults and children was "significantly below average", Mr. Wilmore's warning about having to make the methodology less transparent looks like a euphemism. We are dealing with some very murky waters indeed.

Ronnie Campbell: Will the hon. Gentleman give way?

Tim Yeo: No, given the last intervention I shall not give way; the hon. Gentleman will have to wait a little longer.
	No wonder there seems to be some reluctance on the part of the Government to open up the whole episode to the public scrutiny that it needs. Before considering the effects of that ratings recalculation on the South Durham and other NHS trusts and the patients whom they serve, we need to examine the role of No. 10 Downing street.
	The Health Service Journal broke its story on Thursday 18 December. Not surprisingly, given the reference in the Department of Health's e-mail to the Prime Minister, Downing street was immediately asked for comment. The next morning, on 19 December, the Prime Minister's spokesman was quoted in the Daily Mail, emphasising that, subsequent to the award of the 2002 ratings, responsibility for awarding stars had been removed from the Department of Health. The spokesman attempted to distance Downing street and the Prime Minister from the then Secretary of State's actions, saying:
	"As I understand it, Mr. Milburn queried the star ratings for a number of hospitals, not just this one. In some cases, ratings changed; in other cases, they didn't."
	What the Downing street spokesman did not say on 19 December and what emerged only a couple of days later was that No. 10 had indeed been consulted by the Department of Health at the very time when the then Secretary of State embarked on his manipulation of the ratings. The e-mail from the Secretary of State's office to Mr. Wilmore, which requested reconsideration of the decision to downgrade the rating of the Prime Minister's local NHS trust, was copied to the Prime Minister's health policy adviser at No. 10, Mr. Simon Stevens.
	The extent of the Prime Minister's direct personal involvement remains unclear at present; although I wrote to him about the whole matter before Christmas, I have still received no reply. I trust that when the Secretary of State speaks in the debate, he will explain whether the Prime Minister expressed a view about the matter at the time. I trust that the Secretary of State will also tell us whether Mr. Stevens sent any reply from Downing street to the Department of Health in response to the e-mail that Sammy Sinclair, in the Secretary of State's office, had so helpfully copied to No. 10.
	Let us turn to the consequences of the sudden re-rating of South Durham, because decisions about star ratings are not simply academic. The result of the last-minute upgrade following the then Secretary of State's intervention was to make South Durham eligible for a capital funding grant of £1 million. Very nice, too. But there is no such thing as a free lunch. That £1 million has to come from a finite pot of money—in this case, the £85 million available for three-star trusts. Less fortunate than South Durham was, for example, the George Eliot hospital in the west midlands, one of the six hospitals that had been awarded three stars in the list originally sent to the then Secretary of State on 12 July, but which were mysteriously downgraded to only two stars by the time the ratings were published later that month. Other losers included the City hospital in Birmingham, the Royal Bournemouth and Christchurch hospitals, the Winchester and Eastleigh healthcare trust, and so on.

Ronnie Campbell: I thank the hon. Gentleman for giving way. I am very interested in what he is saying, as it would surely be a good case to take to the parliamentary ombudsman so that she can investigate it.

Tim Yeo: I am grateful to the hon. Gentleman for that helpful suggestion. I had not previously thought of doing that but I shall give it consideration. I am sorry that I did not give way to the hon. Gentleman earlier on—[Interruption.] It was a good suggestion and he is being very helpful.
	The doctors and nurses who work in the hospitals that were downgraded from three to two stars and the patients whom those hospitals serve may conclude that if they had been lucky enough to have one of Tony's cronies as their Member of Parliament they, too, would have enjoyed in 2002 the benefits that three-star status bestows.

Gillian Shephard: My hon. Friend is describing a series of rather murky events, as he puts it, but will he tell the House if the same star-rating system applies to hospitals in Scotland, and whether the current Secretary of State will be protected from the same problems as have apparently affected his colleagues?

Tim Yeo: My right hon. Friend raises a very intriguing issue. Of course we all know that the current Secretary of State will answer today for what went on in northern England, in this case, in a way that he cannot answer for what goes on in Scotland. From what we read in some of the public prints, the waters in Scotland are at least as murky as those in South Durham.
	One of the benefits of three-star status was described by the Health Service Journal in the same issue, which said that it bestowed
	"a place on the starting grid once the race to form the first wave of foundation trusts got under way. Anybody who remembers the formation of the first NHS trusts in the early 90s will understand how valuable being in the vanguard can be."
	We must remember that, back in July 2002, the then Secretary of State advocated a foundation trust model that was a great deal more robust, independent and exciting than the one that the Government, in the face of widespread rebellion from their own Back Benchers, introduced last November. The right hon. Member for Darlington would correctly have judged in July 2002 that the opportunity to be in the first wave of foundation trusts would be a great deal more valuable and advantageous than it eventually turned out to be.

David Hinchliffe: I appreciate that the hon. Gentleman is developing his argument, and I am listening carefully to what he is saying. I have also studied in detail the Health Service Journal piece, which deals with the previous Secretary of State's intervention in respect of a trust in Basildon. Does the hon. Gentleman intend to develop his argument and set out why the Secretary of State also intervened in respect of Basildon, which does not seem to have a connection with himself or the Prime Minister?

Tim Yeo: The answer is that the same article in the Health Service Journal did indeed raise the issue of Basildon, but because I am concerned about the role of Downing street, as well as that of the Secretary of State, I am concentrating on what seems to be the particularly scandalous example of South Durham.

John Reid: Can we take it that that is why the hon. Gentleman has not referred to the other seven trusts that have nothing to do with No. 10?

Tim Yeo: I am perfectly happy if, when the Secretary of State answers, he deals with the one trust with which I am particularly concerned, and we will take his answer as a proxy for how he might have answered on the other trusts that I could have mentioned. Indeed, if he is unable to answer in detail on South Durham, we have to assume that the waters are as murky in the case of all the others as well.
	The Secretary of State has a clear choice this afternoon. He can opt—as I fear he may, given the tone of his interventions—for the cover-up route. He can bluster about how the system has been changed since 2002, how the role of the new Commission for Healthcare Audit and Inspection has been strengthened and how the Department of Health's involvement in awarding star ratings has been reduced, but none of that will alter the facts of the episode that I have just described. The words of the note sent by Mr. Wilmore to the Secretary of State on 16 July 2002 are the smoking gun. Mr. Wilmore had clearly received a request from the Secretary of State—a request that, doubtless, the right hon. Gentleman assumed would never become known to the public, but a request made in an e-mail seen by the Prime Minister's own top health adviser in Downing street.

Nicholas Winterton: Does my hon. Friend accept that what is not important is whether or not the Prime Minister or the Secretary of State made representations in connection with a particular trust? What is important is whether, if other hon. Members had made similar representations to the Secretary of State or the Department of Health, they would have received the same sympathetic acknowledgement of those representations and whether the decision made would be transparent in every way and be justifiable?

Tim Yeo: My hon. Friend is right. Of course any hon. Member on either side of the House is right to make representations about how their local NHS is treated. As my hon. Friend suggests, it is likely that representations from some hon. Members will receive more careful consideration than others. However, the circumstances in this case are indeed very much worse than in the situation that he implies. The Secretary of State and his senior officials were in possession of information about the conclusions arrived at by the methodology already agreed with the commission, and it pointed out that a hospital in which the Prime Minister and the Secretary of State had a direct interest had been downgraded. They chose to use that information in a manner that is wholly lacking in transparency to have those ratings reconsidered—I would say manipulated—to secure advantages for that local NHS trust that are denied to the trusts operating in the constituencies of many other hon. Members.
	As I say, the Secretary of State has a choice today. He can become an accomplice of his predecessor. He can make himself complicit in this tale of ministerial interference, this case where the demands of low politics were put before the needs of patients and professionals. If he chooses that route, he will further undermine the integrity of the whole performance management process in the NHS because, if the people at the very top of the NHS, at the highest level in the Government, cannot be trusted to operate the system objectively, responsively and ethically, the public will have little confidence in the judgments that are reached.
	I urge the Secretary of State therefore to take the alternative route: to announce today that all the relevant documents, e-mails, correspondence and other material will be made public immediately and to welcome any further investigation—whether by the parliamentary ombudsman, as the hon. Member for Blyth Valley (Mr. Campbell) so helpfully suggested, by the Health Committee, which may like to consider the matter, by the Public Accounts Committee or by any other body that decides to inquire into the matter, perhaps including the Health Service Journal. If the publication of that material indicates any wrongdoing or improper interference—either by No. 10 Downing street or by anyone at the Department of Health, including the Secretary of State's predecessor—he should establish a proper, independent inquiry into the whole matter that can be conducted swiftly and report to the House on what actually happened in July 2002.

Christopher Chope: Will my hon. Friend go further and say that hospitals, such as the Royal Bournemouth and Christchurch hospitals, that suffered as a result of the arbitrary action by Ministers should be compensated for the loss that they suffered?

Tim Yeo: My hon. Friend raises a very important issue on behalf of his local hospitals and his constituents. It is perfectly true that, if it appears that that trust suffered as a result of the manipulation of the ratings for political purposes, there is indeed a powerful case for saying that it should be compensated for those losses.

Henry Bellingham: The local hospital in my constituency—the Queen Elizabeth hospital—has two stars. As my hon. Friend rightly points out, there are consequences for not getting the third star, but surely, given all the obsession with targets, stars and ministerial control from the centre, what we need is more local autonomy.

Tim Yeo: My hon. Friend is absolutely right. Of course local autonomy is a key element in our policies to improve the NHS and the lot of patients throughout the country.

Andy Burnham: Will the hon. Gentleman give way?

Tim Yeo: No, I must conclude, I am afraid.
	If the Secretary of State goes down the route that I propose, he will take the first step to redressing some of the damage that this rather shabby episode has inflicted. Opening up the circumstances that led to the re-rating of South Durham is necessary if public confidence is to be restored. I salute the work of Health Service Journal in bringing those facts into the public domain and the courage of those individuals who may have co-operated to help it do so.
	In conclusion, let me remind the House that it is not only the Conservative Opposition who regard the star-rating system as deeply flawed. Jim Johnson, the chairman of the British Medical Association commented last July:
	"Nobody should use star ratings to judge how well a hospital is doing. They measure little more than hospitals' ability to meet political targets and take inadequate account of clinical care or factors such as social deprivation. It is grossly unfair on staff working in low-rated trusts that public confidence in them is being undermined".
	Imagine how the staff felt in the trusts whose ratings went down from three to two stars as a result of the exercise.
	The Conservative party believes that the whole star-rating system should be scrapped. Its effect can be demoralising for staff and it does not provide valuable information for patients. It fails to acknowledge the complexity of the activities performed by the hospitals that it purports to judge. We shall return to the question of why the system is seriously flawed on another occasion. Today, however, we focus on one set of ratings that was unveiled 18 months ago and that has now been exposed as the victim of meddling by a Minister, which was perhaps carried out to curry favour with the Prime Minister—perhaps done even with the connivance or encouragement of No. 10 Downing street itself. I urge the Secretary of State to come clean on behalf of the Government, to publish all the documents that we need in full and to allow an inquiry to be conducted. I commend the motion to the House.

John Reid: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"notes that record investment in the NHS has to be linked to reform, and that this investment and the devolution of power to the front line require greater accountability; congratulates the Government on its record of making the NHS more transparent through the development of performance indicators; welcomes the Government's development of such indicators in consultation with patients and staff; congratulates the Government on giving responsibility for NHS performance monitoring to the independent Commission for Healthcare Audit and Inspection (CHAI), which reports direct to Parliament; and welcomes CHAI's commitment to developing new and more reflective indicators in partnership with representative bodies and the NHS itself."
	This is a good old week for conspiracies. I thought at one stage that the hon. Member for South Suffolk (Mr. Yeo) was going to demand an investigation by John Stevens into the murky deeds that he outlined. Let me make two things absolutely clear at the start. First, I—and all Labour Members—take allegations of this nature very seriously.

Peter Lilley: You do not.

John Reid: Yes, we do.

Peter Lilley: Then why are you laughing at it?

John Reid: Because we do not treat them naively—I thank the right hon. Gentleman for his useful intervention. We are not naive about why such allegations are sometimes made. Today's Opposition day debate is not really about the failings of any Minister, the NHS, the star rating system, or NHS staff. We are under no illusion about why the debate was hyped up, as it was before the holidays. Incidentally, no regard has been paid to the two replies that have been given to the previous demands for an investigation, which amazes me, but I shall come back to that. Today's debate is about the failure of the Tory party—

Andrew Selous: Will the Secretary of State give way?

John Reid: For goodness' sake, let me at least start. I know that Conservative Members want to pre-empt every investigation—their leader pre-empted the Hutton investigation today—but rational people without malicious intent allow the other side to have a say before intervening. [Interruption.] Conservative Members do not necessarily benefit from shouting down a speaker either.
	Today's debate is much more about the Tory party's failure to come to terms with one simple fact: the national health service has improved, is improving and will continue to improve. If I may use a metaphor, that is really what gets up its nose. [Interruption.] Opposition Members may say, "Rubbish", but we know that that is true, courtesy of the revelation of the former Opposition spokesman on health—now the half-chairman of the Conservative party—who was candid enough to tell us explicitly what his party's agenda was. He knows that if the improvements continue, and if people outside the House see them, Tory plans to undermine the national health service will themselves be undermined. His quaint words were:
	"If Labour fix the national health service we are"—
	I do not know what the final word beginning with "F" is—it is presumably "foxed". We know the Conservative party's agenda and why on every occasion it attempts to denigrate any achievements by people working in the health service, as it does with the case that we are debating. Although we take the subject seriously, we do not do that naively. The debate is a politically motivated personal attack to harm the national health service as well as the Labour party.

Kevan Jones: My right hon. Friend knows that I have been critical of the new health trust in Durham and the way in which it has been managed—I continue to have those reservations. However, three hospitals have been built in Durham since 1997, so does he agree that the situation is different from that under the Conservatives? A new hospital opened in my constituency last year, which replaced a hospital that was the old workhouse. There is a new £97 million hospital in the city of Durham and at Bishop Auckland. That represents a true record; the actual disgrace is the fact that the Conservatives never bothered about health care or investment in the county of Durham.

John Reid: I entirely agree with my hon. Friend. The reality of the record is there for all to see. However, the Conservatives minimise any achievement in the NHS, maximise and magnify any failure—failures do happen—and put every success down to fiddling managers, cheating staff or, now, corrupt Ministers because they cannot stand to see the improvements. Let me turn to some of the details.

Andrew Selous: rose—

Crispin Blunt: rose—

John Reid: I shall give way if the hon. Gentlemen allow me to go through some of the narrative on this.
	The motion attacks not only my predecessor as Secretary of State—I wish that the hon. Member for South Suffolk had read the motion, which was presumably written for him and tabled in his name—but targets, performance indicators and the whole system of evaluation. The Opposition consistently attack performance targets and indicators, but the targets have been absolutely essential to the improvements in the NHS over recent years. They have resulted in our drive that has achieved 14,000 more doctors, 15,000 more nurses and almost 400,000 more operations. They have resulted in a 10 per cent. reduction in cancer mortality for under-75s and a 23 per cent. reduction in cardio-vascular related deaths among people aged under 75. Speedier operations are reducing waiting times. The Government stand by the achievements and the way in which we managed them, which was partly through the targets and performance indicators that are attacked by the Conservatives.

Andrew Selous: Will the Secretary of State give way?

John Reid: I will give way after I have concluded my introductory comments. The motion for which the hon. Member for South Suffolk asks us to vote also attacks the transparency that we have introduced. That transparency is the basis for increased patient power. The wider availability of patient information, which for the first time since the formation of the NHS increases vastly the control exercised by ordinary members of the public over their health service, is dependent on that transparency.
	The Conservatives also attack star ratings, which, for the first time, provide information about local health services and focus attention on what is important to patients and the public. None of their attacks arises by accident, and I shall continue to try to illustrate why they arise and go through the narrative of what happened during the events to which the hon. Member for South Suffolk referred partially, but not fully.

Andrew Selous: rose—

Crispin Blunt: rose—

John Reid: In fairness, I shall give way to the hon. Member for South-West Bedfordshire (Andrew Selous) first.

Andrew Selous: Will the Secretary of State assure the House that there will be no further use of terms such as "high-profile trusts" from anyone in his office merely according to the seniority or status of the relevant Member of Parliament? If our constituents think that health care is allocated according to the eminence or otherwise of their MP, it is an extremely serious matter.

John Reid: I do not know whether that is a major question, but I shall treat it seriously although I have misgivings about whether it is actually serious. I take it that the hon. Gentleman has looked at the e-mails. If he checks them, he will see that the phrases were introduced not by anyone in the private office of the previous Secretary of State or, indeed, the previous Secretary of State, but by another official. That official does not work in the office of the Secretary of State or, indeed, Richmond House, but in Leeds. The phrase "high-priority" was shorthand and a completely innocent way of referring to several trusts.
	Secondly, the phrase was not meant to define the trusts with major or high-priority politicians. If the hon. Gentleman reads the e-mails again, he will see that several other trusts are mentioned in that context—for example, from memory, the e-mail mentioned Great Ormond Street. When the former Secretary of State responded to it using the phrases and phraseology solicited from him, he referred to not one but nine trusts, one of which was subsequently moved up. That trust happens to be the local trust of a prominent Conservative Member, although she had nothing to do with the process. The interpretation of partial analysis of fragmentary so-called evidence by the hon. Member for South Suffolk is therefore utterly unjustified.

Crispin Blunt: The issue is the political manipulation of the health service, and the right hon. Gentleman should be aware that his Department and his predecessor have a record in that regard, not least in my constituency and that of the hon. Member for Crawley (Laura Moffatt). Our hospitals were put together in a trust following an organisation programme agreed by the Department, which was unpopular in Crawley, as services were moved to my constituency. The right hon. Gentleman's predecessor ordered a moratorium two months before the general election in 2001 at a cost of £50,000 a month, as we established through parliamentary questions. The Department has refused to let me have the advice given by the trust, which was against the moratorium, both in principle and because patient safety was involved. If the Secretary of State is going to address the need for greater transparency in the health service, will he give an undertaking that I will get a copy of the advice that the trust gave at the time of his predecessor's decision?

John Reid: There is a simple way, as the hon. Gentleman knows, to get information that is classified as confidential and privy to Ministers and their advisers. It is called an election, and such information is available to the elected Government, as the hon. Gentleman well knows because, as a former adviser to a Conservative Defence Secretary, he was privy for a number of years to information given in confidence to Ministers and on which assessments were based. Much of that information would have been of interest to hon. Members, but he was not expected to reveal it, and I am not prepared to reveal information that is confidential to Ministers and their advisers. That is how it will stay.

Angela Browning: rose—

John Reid: There will be plenty of opportunity for Members to intervene later.

Crispin Blunt: On a point of order, Mr. Speaker. The Secretary of State does not appear to understand the consequences of the Freedom of Information Act 2000, which allow me—

Mr. Speaker: Order. The hon. Gentleman is trying to draw me into the debate. This is not a matter for the Chair, but a matter for debate.

John Reid: rose—

Tim Yeo: Our debate is developing rather significantly. The Secretary of State accused me, I think, of relying on fragmentary evidence, but the solution to the problem is in his own hands if he publishes the documents. In relation to that request, he referred to parts of an e-mail, which did not appear in Health Service Journal, and mentioned Great Ormond Street hospital, which was not referred to anywhere in Health Service Journal. However, now that he has referred to that e-mail, is it not correct that he should place a copy of the full text in the Library?

John Reid: If we are talking about the fragmentary nature of evidence, there was a glaring omission in the hon. Gentleman's own speech. I find it astounding that he failed to refer to the reply that the Conservative party chairman received from no less a person than the Cabinet Secretary—[Interruption.] If I could deal with the matter in hand. The hon. Member for South Suffolk may not share my opinions, but it would be helpful if he showed courtesy to the House.
	The Cabinet Secretary, Sir Andrew Turnbull, sent a letter dated 23 December to the hon. Member for Woodspring (Dr. Fox), in response to a letter from the chairman of the Conservative party. Naturally, I shall place Sir Andrew's letter in the Library. It is astounding that the letter, which was the first reply to the first demand for a Downing street investigation from the Conservative party chairman, has apparently not been shown to the hon. Member for South Suffolk, who spoke at considerable length about Downing street without revealing to the House the Cabinet Secretary's reply. I shall therefore remind him of what it says. He is looking puzzled—I do not know whether his party chairman has informed him of the letter. I know that there has been a holiday, but presumably they spoke on the phone to wish one another happy new year, and the matter might have been raised. In the letter, the Cabinet Secretary says:
	"I have looked into the involvement of No. 10. As they have already made clear, the adviser covering health matters, Simon Stevens,"—
	to whom the hon. Member for South Suffolk referred—
	"is routinely copied policy papers from the Department, and he was one of 65 people on the copy list for emails on the criteria for awarding star ratings. He did not intervene in this correspondence regarding South Durham nor any other NHS Trust. Nor did he raise the issue with the Prime Minister."
	It is astounding that the hon. Member for South Suffolk did not share that information with the House. To paraphrase the Leader of the Opposition, we will take no lectures about allegations of a cover-up when the Conservative health spokesman has not even revealed that the questions he asked have been answered by no less a person than the Cabinet Secretary.
	None of these attacks has happened by accident. The attacks are part of the Conservatives' unsuccessful attempts to undermine the efficacy and reputation of the national health service, and have nothing to do with discovering the truth.

Tim Yeo: On a point of order, Mr. Speaker. I asked the Secretary of State in my intervention a few minutes ago whether he would place in the Library a copy of the e-mail to which he referred and which is partially quoted in the Health Service Journal. Is it not a convention of the House, Mr. Speaker, that when a document is referred to and sections are quoted by a Minister that have not previously been quoted, it must be made available to hon. Members by it being placed in the Library?

Mr. Speaker: There is a distinction, as an e-mail is not a document, so the matter is at the discretion of the Secretary of State. However, there is no requirement for e-mails to be placed in the Library. [Hon. Members: "That is new."] Order. E-mails are relatively new, which is why I have to make a ruling that previous Speakers did not have to make.

John Reid: Thank you, Mr. Speaker. Having grabbed two jobs, I thought that the hon. Member for South Suffolk was beginning to encroach on yours.
	Let me make it clear that we are committed to providing patients, the public and, indeed, the House with credible, comprehensive and easily understandable information on how their local NHS organisations are performing. That is the primary purpose of star ratings. Our starting point—the premise that has been questioned in today's debate—is the Government's belief that the public need more information about how health services are working, both because their health is important to them and because public money pays for those services. It is precisely because we have asked the public to increase the money that they pay for the health service that we have increased public accountability and transparency through mechanisms such as the performance ratings.
	That is why, in July 2000, for the first time ever, the Government introduced the concept of national health service performance ratings and the annual publication of information on all parts of the service. The rating awarded was to be based on an organisation's performance against a number of key targets such as waiting times and a wider set of "balanced scorecard" performance indicators. The hon. Member for South Suffolk said that he is troubled by three things. First, he is troubled that a Minister should respond, intervene or make queries about these issues. Secondly, he is troubled that a Minister should do so late in the process and shortly before publication. Thirdly, as I understand it, he is troubled that gradings were changed late in the ratings process. That is the essence of his concerns if we cleave away the conspiracy element.
	I shall try to address those issues, and take the House through the development of the ratings process, which was pioneering, complex and difficult. Hon. Members should remember that it was not just about grading hospitals or trusts but about establishing and developing a grading system for the first time, which was as difficult as it was important.
	The first set of ratings was published in September 2001, covering the performance of acute trusts in 2000–01. They were produced and published by my Department. We did not pretend then, nor do we yet claim, that those criteria were or are perfect in every way. Indeed, given the novelty of that pioneering approach to transparency, it could not be perfect at the first, second or even third attempt. We said so explicitly at the time.
	We made three things clear at the very beginning: first, that the assessments were not perfect, but were based on the best available data and that we would aim to improve those data sources; secondly, that the data criteria—not the data, but the criteria for assessing performance—would also be refined and improved over the years ahead; and thirdly, that we would be working not only with trusts and the independent Commission for Health Improvement, but most obviously towards this end, within the Department of Health itself in the initial stages. In short, this was the establishment, development and refinement of an iterative process—one that was changing by the day and by the month, and which is still changing by the year.
	That is the primary context that must be understood if we are to take a mature look at how things happened and what happened, rather than throwing it all aside and assuming that there is a great conspiracy behind everything that changes in Government and outside of Government.

Stephen Dorrell: The Secretary of State is placing great emphasis on the fact that the star ratings published in 2001 were the first time, in his view, that NHS trusts had been asked to account in public for their performance against pre-announced key performance indicators. Can he confirm that it was, in fact, my predecessor as Secretary of State for Health, my right hon. Friend the Member for South-West Surrey (Virginia Bottomley) who introduced in the mid-1990s a system of publication of results by NHS trusts against key performance indicators, and that they were refined during my time as Secretary of State? It simply is not true to suggest that the star ratings published in 2001 were published out of the blue, with no previous experience in the health service or the Department of Health for the exercise on which they were embarking.

John Reid: With all due respect to the right hon. Gentleman, we do not have a difference of principle, but the level of sophistication, complexity and intricacy of what we are doing now is light years away from anything that was done previously. That is not to detract from the fact that he and his colleagues at the time pursued that route for a while. I am not suggesting that they did not, but as someone who has borne the responsibility in government, he would be the first to accept that when one implements such initiatives in education or health, there is an ongoing discussion and debate.
	Time after time, at Question Time and in debates, the Front-Bench spokesman prior to the hon. Member for South Suffolk got up and criticised me robustly and in some ways, perhaps, legitimately for some of the criteria that are used—non-clinical, non-medical criteria. I shall return to that point, because it is not only from one side of the House that we receive practical challenges to evaluate the criteria.

Stephen Dorrell: I am grateful to the Secretary of State for giving way again, and for his recognition that some groundwork was done in the 1990s. Perhaps he will reflect on the gap between the work that we did and the work that he and his immediate predecessor are seeking to do to enhance accountability in the NHS. There was an interruption between 1997 and 2001, and the Secretary of State might care to reflect that we would have made further progress if the incremental approach, which he is rightly espousing, had been allowed to develop through that gap in the process.

John Reid: The right hon. Gentleman tempts me down a road down which I do not want to go. It is fair to say that as human beings in a complex world, the incumbent of my position during the relevant period would not agree with everything that I do, and I do not necessarily agree, on reflection, with everything that was done during that period. We will let the matter rest there.

Howard Stoate: rose—

John Reid: I shall give way now, then I shall make a huge amount of progress before I give way again.

Howard Stoate: Can my right hon. Friend clarify a couple of points for me? First, the Opposition are presumably suggesting that the trust should not have had its third star and deserved only two, which is a kick in the teeth for the enormous amount of hard work and energy put in by many people who work for it. Secondly, those on the Opposition Front Bench seem to want to scrap the entire ratings system and performance indicators, yet the right hon. Member for Charnwood (Mr. Dorrell) claims credit for it. Perhaps my right hon. Friend could unravel the Tories' thinking on this important issue.

John Reid: Again, my hon. Friend tempts me to make invidious comparisons. I listen with great respect, not because of personalities, but because some Opposition Members, such as the right hon. Member for Charnwood (Mr. Dorrell), have held high office in the Department of Health.

Kevan Jones: rose—

John Reid: Will my hon. Friend allow me to make progress?
	I was saying that the process was an iterative one—a process of development and refinement, and discussions were going on inside the Department of Health and externally, with trusts, among others. The system was still under development when the next set of ratings, covering performance in 2001–02, were published in July 2002. If we want to define the changes that were taking place, we should note that a broader set of indicators was used, more account was taken of the CHI reviews of clinical governance arrangements, and the ratings were extended to cover specialist trusts and ambulance trusts for the first time, and to include indicative ratings for mental health trusts. A great deal of change was taking place.
	Again, put simply, the process of verifying data and refining the indicators to be used ran right up to the point of publication—the second element that worries the hon. Member for South Suffolk—precisely as it did the year before, which was the first year of star ratings. As anyone who has been involved in Government would know, when publishing large amounts of data it is quite normal for that to happen, particularly when the policy is in its early stages, when such large amounts of data are involved, and in this case, in 2002, when the release had been brought forward two months from September to July, putting greater pressure on the scrutiny and verification of the data and the final publication.
	We were sensitive to the need to be able to justify publicly and to the organisations concerned changes in the ratings, especially when they arose from additional indicators that we were using for the first time. I have nothing but praise, in retrospect, for the amount of work that was done by our officials and civil servants. I hope that it was not meant in that way, but there is an innuendo in the remarks of the hon. Member for South Suffolk. The officials in the Department, who are people of great integrity and commitment, would not involve themselves in something that they perceived to be a political stitch-up. That has been clear to me in the many Departments in which I have worked. Let us reject that implication out of hand.
	The Department was concerned to be able to justify publicly the nature of the criteria and the verifiable accuracy of the data. For that reason, and to ensure that the published information was as accurate as possible, NHS trusts were given the opportunity to comment on and to ratify the indicator constructions to confirm that they were correct prior to publication. In addition to the trusts, others were represented.
	A significant number of NHS organisations—estimated at the time to be close to half of those who made representations during the ratification process—expressed concern with data quality on two proposed indicators being used for the first time in 2002. Those indicators were access to catering facilities, and information management and technology. If one were caricaturing the situation, as the Opposition sometimes do, one would define the criteria as 24-hour canteen facilities and 24-hour web-browsing facilities. During the consultation, a significant number of queries were raised about whether those were serious criteria.

Andrew Lansley: rose—

John Reid: Will the hon. Gentleman allow me to finish this narrative? It is extremely important.
	It was clear that those indicators were not of a high enough quality and that the issue could not be resolved in time for publication of the ratings. I am advised by those who were involved as officials at the time that even if the timetable from the previous year had applied, there would not have been time to improve those particular indicators. They could not, therefore, be included in a refined and improved form in the final set of indicators. They could, of course, be removed.

Andrew Lansley: I am grateful to the Secretary of State for giving way. He has described the discussions with trusts, and presumably the Commission for Health Improvement, that led to the submission to the then Secretary of State on 12 July. The point, however, is what happened that led to the change in the ratings between the 12 July submission and publication on 24 July.

John Reid: A little trust from the hon. Gentleman would be welcome. I am taking him through a narrative. I started in one year and I am moving chronologically. Consultations and discussions did not stop on 12 July, but continued. My point is that, even before the Secretary of State and Ministers were asked about the issue, a huge number of trusts that had been consulted—the estimate at the time was up to 50 per cent.—indicated dissatisfaction or problems with two particular criteria. As it happens, they were the criteria that were removed, which might be taken to show that they were not removed purely on the say so and diktat of the Secretary of State or purely in respect of one trust. Indeed, the Secretary of State mentioned nine trusts, and I shall go on to tell hon. Members where the movements occurred. All these suggestions take the conspiracy approach of the front page of the Daily Mirror to produce.

Several hon. Members: rose—

John Reid: Let me make some headway; I shall come back to the issue.
	The change to which I have referred and which others made during the final weeks inevitably had an impact on the ratings. Some trusts benefited, while others lost out. Another part of the information that was not mentioned earlier is that, after 12 July and before publication on 24 July, not one trust, but 23 of them—[Interruption.] I urge the hon. Member for South Cambridgeshire (Mr. Lansley) to listen. After 12 July—

Andrew Lansley: Will the Secretary of State give way?

John Reid: No; this is a crucial point, and I make it in response to a demand that was made constantly from the Opposition Front Bench. After 12 July and before publication on 24 July, not one or two trusts, but 23 of them, received a higher rating—I might add that they included the trust serving the constituencies of Maidstone and The Weald and Tunbridge Wells—while 10 trusts received a lower rating, including those serving the constituencies of Dewsbury and South Shields. People who try to identify a political pattern in what happened and thereby attribute it to a conspiracy are doing a disservice to the hard work of the officials and the trusts themselves.
	The Opposition are today asking for another inquiry into the matter. As I pointed out, one of the two chairmen of the Conservative party requested an investigation from the Cabinet Secretary. The Cabinet Secretary also took it upon himself, I think legitimately and with due diligence, to ask the permanent secretary in my Department to conduct an investigation. He wrote this morning to the chairman of the Conservative party. I am surprised that the hon. Member for South Suffolk has not been informed by his party chairman. [Interruption.] Apparently, he has now received that information. To be helpful, I shall read out just two paragraphs of the letter, which I shall place in the Library. I quote the permanent secretary:
	"Ministers were, quite properly, involved in the process of developing the ratings system—which was one of the key commitments of the NHS Plan—and in preparing the announcement of the results for which they were Departmentally responsible. As part of ensuring that changes to the ratings of individual Trusts could be justified by reference to robust evidence, officials rightly highlighted individual cases to Ministers and they, legitimately, raised questions about other cases, including South Durham. One category of cases highlighted in this way—which included at one stage South Durham—were 3 Star Trusts at risk of losing a star. Naturally Ministers wanted to be reassured that any change in the ratings was a result of a genuine change in performance."
	He begins the next paragraph thus:
	"The ratings of some of the Trusts under discussion at this stage of the process did change as a result of the changes to the methodology which I have described. In other cases they did not."
	Here is the important point:
	"I am satisfied that no changes were made to the methodology in order to manipulate the rating of any individual Trust. I am also satisfied that political considerations played no part in any of these decisions."
	Let me repeat that sentence:
	"I am also satisfied that political considerations played no part in any of these decisions."
	I shall wait to see whether, having attacked trusts and managers and referred to cheats and fiddlers in the NHS, those on the Opposition Front Bench are now about to attack the permanent secretary at the Department of Health and Sir Andrew Turnbull at No. 10 Downing street. The fact is that the situation with regard to the crucial question could not be clearer: no political considerations were involved. In view of the relevance of Sir Nigel's letter to the motion, I have obviously asked for a copy to be placed in the Library.
	There is nothing unusual about changes to provisional star ratings status occurring prior to publication. We could look at many trusts and see changes in the weeks beforehand. Given the importance of the data, we recognise that we have to ensure that we continue to progress the independence of the system. I can tell the House that responsibility for continuing to ensure a robust system of performance ratings for the third year of publication and for July 2003 was passed to the independent Commission for Health Improvement in 2002. The new Commission for Healthcare Audit and Inspection will take over responsibility for the ratings process from April 2004 and will publish the 2003–04 ratings as part of its annual report to Parliament this summer. It is independent of government and will continue to ensure the integrity of the ratings.
	In short, within three years, the Government have developed the data on which to base the performance and published them, and we have now made sure that responsibility for the publication of the data and criteria will be completely independent of government. In contrast, we know from the motion what the Opposition believe in. The motion calls for greater transparency in the calculation and publication of performance indicators throughout the NHS and goes on to express concern that these indicators might be used by people to indicate performance. If we check that position against the Opposition's actions, we see that it is difficult to find a bigger piece of hypocrisy, even in the Conservative party. Its actions in every conceivable area belie what it is demanding in parts of the motion.

Kevan Jones: Will my right hon. Friend give way?

John Reid: I shall do so for the final time.

Kevan Jones: I am grateful to my right hon. Friend for again giving way. The history of star rating that we have been given this afternoon has been interesting for the anoraks, but may I draw his attention to the fact that the abolition of the South Durham trust and the transfer of most of its management, including the chief executive, to the new County Durham trust raises issues that need to be addressed, including concerns among my constituents and others in Durham? For example, last week, the accident and emergency department of the new University hospital, Durham, was closed to new admissions because of lack of beds. Instead of talking about historic star ratings today, we would have been far better off discussing the investment that has gone into Durham and the management of the NHS trust there.

John Reid: I agree entirely with my hon. Friend. As he and other colleagues have pointed out, the Opposition are attacking trusts for the good work that they have done, and not only those in Labour areas are affected. Interestingly, one of the results queried by the previous Secretary of State was that of the West Suffolk hospital trust. I recommend that the hon. Member for South Suffolk listens, as the issue has some relevance to him. That trust serves the constituencies of three hon. Members, all of them from the Opposition Benches. Indeed, it includes South Suffolk, the constituency of the Opposition spokesman who opened the debate. Presumably, a sub-plot of the conspiracy is held to be that the previous Secretary of State was doing his damnedest to ensure that the hon. Gentleman's trust was moved up the ladder as well. That illustrates the ludicrous nature of the conspiracy that has been proposed today. It is the usual thing from the Conservatives. That is why they claim that nothing is getting better in the health service, that the NHS cannot improve, and that if it does improve, it is all a fiddle or a conspiracy. That is why they denigrate and diminish everything that is done by the 1.3 million people who constitute the biggest army for good in western Europe—the staff of our national health service.
	The Conservatives know that slowly but surely NHS performance is improving. They know, equally surely, that the public and the electorate will reject their attacks on the NHS and, in doing so, will reject their failed, dogmatic policies—just as we should reject this cynical, opportunistic and politically-motivated motion and vote for the amendment that was tabled in my name and that of the Prime Minister.

Paul Burstow: This is proving an interesting and useful debate. In his response, the Secretary of State answered some of the questions, but gave rise to several others that I hope that the Minister will be able to address. Not long ago, on another Conservative Opposition day, we debated the target-setting culture in the national health service and the way in which it provokes changes in behaviour in the NHS that are not always those that are intended—indeed, poor target setting can be corrosive of NHS morale and lead to perverse outcomes.
	During that debate, we focused on the way in which targets and performance indicators can distort clinical priorities and lead to unintended consequences; today, we are focusing on the important exposé in the Health Service Journal and the information that it helpfully brought into the public domain. I hope that the Secretary of State will agree, even at this late stage, that that process should go further to ensure that we have all the information about the star ratings process and the build-up to its publication in 2002. A few bits have been teased out today, but there is still more to come.
	There is a fine line between what one might call the fine-tuning, data checking and reality checking of performance indicators and star ratings and the fiddling of figures. On the basis of the evidence that was published in the Health Service Journal before Christmas, one could conclude that that line has been crossed. I want to return to the letters that the Secretary of State mentioned, because they raise further questions.
	The basis on which the 2002 star ratings were calculated was changed—that is accepted. The Secretary of State tells us that that is part of an ongoing, iterative process. They were changed at the last minute, and the change had a real effect. Nine trusts went up from two to three stars and six went down from three to two stars. As a consequence, those six trusts were, in effect, robbed of up to £1 million each for service improvements that would have been available to them had they been three-star trusts. In addition, they were denied a range of modest, but nevertheless welcome, freedoms and flexibilities that are part of the star rating system.
	The Health Service Journal documents the e-mail exchanges between the office of the former Secretary of State and the head of the performance development unit in the Department, Mr. Wilmore, who warned on 12 July 2002—this has been quoted before, but it is important to my argument:
	"Unfortunately even if time allowed it, further revisions to the methodology to promote these trusts would inevitably lead to other individual results we had not expected, as well as making the scoring system more complicated."
	The Secretary of State has laboured the point that so far the debate has focused on South Durham. That will not be the thrust of my argument, because the key question is not whether the methodology was changed to fix it for one trust, but whether it was changed inappropriately, at the last minute, with unforeseen consequences for a number of trusts that hitherto would have had three stars and all the benefits that flow from that. That is why Basildon and Thurrock general hospital was one of those mentioned in the official's report to the then Secretary of State. He said:
	"Adjustments to the methodology would have to be severe to move the trust to three stars and would inevitably demote other high profile trusts in the process."
	In his response to the hon. Member for South Suffolk (Mr. Yeo), the Secretary of State said, effectively, that the main changes to the methodology concerned catering services and information management. Yet the paper that was sent to the Secretary of State at the time, which was the basis of the article in the Health Service Journal, says that the reason why Basildon and Thurrock general hospital was not going to secure a three-star rating was because of the patient-focused element in the methodology, and specifically because of the results from the patient survey. I wonder, therefore, how that methodology was changed to reflect a high three-star rating for that trust in the final run of the star rating calculations for 2002. The Secretary of State has not yet dealt with that.

John Reid: I hope that this will be helpful to the hon. Gentleman. As regards his suggestion that things were done late, they were done continually; some were done late. My hon. Friend the Minister will respond to that. The key word in his argument is "inappropriate", because we believed then, and believe now, that the changes were appropriate, and such changes continue. It is important to remember that changing one or two indicators will not affect the majority of trust results, but it will inevitably affect some—not only one—because the star rating system uses the relative position of trusts against a wide range of balanced scorecard indicators to help to distinguish between two-star and three-star trusts. That means that a trust's position can be improved or worsened by changes to the indicator scores of other trusts. That is the essence of the relativity effect whereby changing one indicator can affect a series of trusts, which, in turn, affects other trusts because of their relative performances.

Paul Burstow: I am grateful to the Secretary of State. That implies that the removal from the methodology of catering and information management did constitute a severe change in terms of that official's advice and warning to the then Secretary of State on 12 July 2002. I will look at what the Secretary of State says, because I accept that he is trying to be helpful.
	Mr. Wilmore asked the Secretary of State's office for comments by 15 July, and received an e-mail that stated that the
	"Secretary of State would also identify South Durham as a high profile Trust"—
	we heard earlier that the Secretary of State's office had used the words "high-profile trust"—
	"given it serves the Prime Minister's constituency. Why has it fallen from three stars last year to two stars?"

Paul Tyler: That further suggests that there are some low-profile trusts. I hope that my hon. Friend agrees that there should be no such trusts. A quite different set of categories, which appears to be political rather than based on any clinical need, is being introduced into the discussion.

Paul Burstow: My hon. Friend makes an important point. I hope that the Minister will accept that "high-profile trusts" is an unfortunate use of terminology that should not have crept even into an e-mail that was not expected to become as widely disseminated as it has.
	In response to the e-mail, Mr. Wilmore stated:
	"Alterations to the methodology have been made, resulting in the changes to individual trusts that were requested. This makes the scoring methodology more difficult to explain and less transparent."
	He continued:
	"An explanation of the revised methodology has yet to be written up."
	Will the Secretary of State put into the public domain the detailed write-up of the methodology that followed the further recalculation that led to that exchange of e-mails? That would be a useful document in terms of understanding what the Secretary of State has said to me and to the hon. Member for South Suffolk.
	Mr. Wilmore then notes that Basildon and Thurrock and South Durham
	"now receive a three-star rating".
	His paper offers no further explanation of why South Durham was originally downgraded from three to two stars and does not attempt to answer the Secretary of State's perfectly legitimate question about why that change occurred. It will be interesting to have the answer so that we can be clear about the way in which the methodology and other processes that contribute to a star rating were affected to produce the outcome in 2002.
	We also know that the exchange of e-mails was copied to the Prime Minister's health adviser and we are told that the relevant e-mail was not acted upon. Does that mean that the e-mail was not read? Given that the Prime Minister's health adviser apparently routinely receives copies of e-mails between Health Ministers' private offices and the Department, what does he do with them? I am told that he is dynamic, proactive and hands on. The nature of e-mail drives people to respond and I am therefore puzzled that the health adviser did not respond and possibly chose to open it and do no more.
	A question, which I hope the Minister who responds to the debate can answer, about the Prime Minister's knowledge of events has not been asked. It is not whether his adviser, on the basis of the e-mail exchanges, notified him of the specific anxiety about the high-profile trust, but when he became aware of the South Durham star rating. It would be useful to have that specific piece of chronology.
	Since the publication of the e-mail trail, the official line has comprised two elements. First, what happened is part of the normal process of signing off the star ratings, which would be subject to adjustments and corrections every year as part of the iterative process. Secondly, the responsibility for finalising and publishing star ratings is now that of the Commission for Healthcare Audit and Inspection—as if that makes okay anything that was inappropriate in the past.
	The unofficial line that the right hon. Member for Darlington (Mr. Milburn) has taken is that it is all a load of tosh. I hope that that is a parliamentary term and that I can therefore use it. How can it be tosh for a senior official to warn the Secretary of State that changes to the method of calculating the 2002 star ratings made them more difficult to explain and less transparent?
	I want to ask a few questions of the Minister who will reply to the debate. First, why were the changes made so late in the day, after they had been reality checked? That is especially relevant to the trusts that were part of the system in 2002. Secondly, why were the warnings of the head of the performance development unit about the difficulties of making the changes at such a late stage ignored? Thirdly, what changes to the methodology led to such a big shift in the star ratings but did not affect the trusts with zero star ratings? Again, that relates to the detailed write-up of the methodology that I requested earlier. I hope that the Secretary of State or the Minister who replies to the debate can provide that.
	The handling of the 2002 star ratings must give rise to questions about that of the 2003 ratings. In 2003, for the first time, the Commission for Health Improvement was responsible for publishing them, but it would be strange if the Department had not maintained a close interest in the way in which CHI was taking the work forward. As well as publishing all the Department's material that was relevant to the 2002 star ratings, will the Secretary of State undertake to publish all papers and e-mails about the methodology and weightings for each element of the 2003 star ratings, in the interest of restoring public confidence in the star ratings system, which he clearly wishes to achieve?
	The way in which the 2002 star ratings were handled raises wider questions about performance monitoring in the NHS and the way in which data are collected and published. In November last year, the Nuffield Trust published its mid-term review of the Government's progress in delivering improvement in the NHS. The report was positive—I am sure that that pleased Ministers. However, there was a sting in the tail. One of the report's authors, Professor Sheila Leatherman said:
	"There are significant data and analytic weaknesses in the NHS which mean carrying out a comprehensive, robust, definitive, transparent and defensible assessment is impossible.
	The unrelenting and distracting problem of inconsistent and highly contested data throws the whole of the quality agenda into a confusing fray."
	Until the data are collected, audited and published independently of the Government, how can the public have confidence that their money is being spent wisely?
	In its report, "Performance Indicators: Good, Bad and Ugly", the Royal Statistical Society calls for performance indicators to be accorded the same status as national statistics. In other words, the process should be clearly independent and at arm's length from the Government, to an even greater extent than the new Commission for Healthcare Audit and Inspection allows.
	The report detailed several pitfalls that we discussed in the Chamber when we previously considered target setting, not least that performance measurement can create unintended consequences and lead to manipulation of data, gaming or fraud by service providers. Indeed, the Audit Commission and the National Audit Office found that in reports that they published last year.
	Performance measurement changes behaviour. The Royal Statistical Society stated:
	"Behaviour change is a factor because no performance measurement scheme can be viewed in isolation from the incentives—designed or accidental—that exist alongside it. Designed incentives often take the form of targets, and set of consequences associated with performance. If the assessment of management functions in the NHS depends centrally on whether explicit waiting time targets are secured, then this can affect such things as patient handling among health care professionals."
	In other words, what gets measured gets done.
	The Secretary of State recently told the Select Committee on Health that the Department was reviewing its data collection.

Stephen McCabe: I am following the hon. Gentleman's argument with interest. What does he want to have done but not measured? Can he give some examples?

Paul Burstow: I am about to deal with the review of data collection, about which the Secretary of State told the Health Committee. [Interruption.] I shall answer the hon. Gentleman's point in my own way and in due course, if he does not mind.
	The Secretary of State told the Health Committee that the Department was reviewing its data collection with a view to rationalising what it collects. The NHS confederation has expressed concern for some time about the burden of reporting requirements on the NHS. In December, after a year of consultation and discussions, the Confederation published its report, "Smarter Reporting". The report found that more than half the information requests from the Department were perceived not to be useful for managing NHS trusts, either because it asked for duplicate information or because the data were of questionable value.
	The survey also found that a quarter of returns that the Department required were wholly or partly duplications. Much could therefore be stripped out of data collection without materially affecting the value of the data that the Department is currently gathering. Simply cutting back the duplication would make a difference. Rationalising data collection helps to improve the quality of the data that are being collected.
	In the conclusion to its report, the NHS Confederation warns that the exercise that the Department is currently undertaking entails a risk of losing the value of data collection in the existing system. I hope that the Secretary of State can assure us through the Minister who responds that an extensive dialogue is going on with the NHS Confederation and others to ensure that we get the best data collection and fill the gaps when that will add something to our understanding of service development, policy development and performance in the NHS.
	Liberal Democrat Members will support the Opposition motion because we believe that there is a need to bring into the public domain information, which is not there, about what happened in 2002. We are critical of the way in which the star rating and performance management system has been rolled out in the past few years. It is clear from the events that surrounded the 2002 star rating that the process and reporting have damaged the credibility of the star ratings system. Indeed, they have dealt it a fatal blow. How can the public have confidence in the current star ratings system? What messages have been sent to NHS staff, especially those in trusts that lost their third star because of the recalculations? They were told one minute that they were an excellent trust, then suddenly that they were considered middle rating. What message does that convey?
	We will support the motion. The NHS is improving, but we need a reliable system that enables us to know that it is improving. That currently does not exist. Until it does, we cannot support the star ratings system.

Mr. Deputy Speaker: Before I call the next speaker, I inform the House that Mr. Speaker has placed a 10-minute limit on Back Benchers' speeches. That will apply from now.

Siobhain McDonagh: Whenever the star rating system is put under pressure or attacked, I feel the need to make a contribution in its defence on behalf of my constituents. It is the first system to allow people in my constituency to be heard on the subject of the performance of their local hospital. All my constituents, half of whom use St. Helier hospital, knew before 2000 that it was not up to scratch, that it was too dirty, and that the services provided were not good enough. Contributions from me, as the local Member of Parliament, and from the community health council, and missives presumably from the Department of Health all had no effect. The then chief executive carried on and refused to listen to the problems that existed. The only thing that broke that logjam was the star rating report that roundly, fairly and justly gave St. Helier hospital no stars.
	That marked the beginning of the improvements in my local hospital. It also meant that there was perhaps a distortion in the allocation of funds, because funds came to that hospital for the first time for the improvement of its Nightingale wards and its standards of cleanliness. For the first time, the hospital examined how elderly people in the geriatric wards were cared for, and whether they were being provided with food but not fed. Elderly people were actually starving in the wards. The fact that the star rating system can achieve those improvements, and that it allows the public to know that the Government know what they know, is essential.
	The system has led to enormous improvements in the services that people in my constituency receive today. I am not saying that St. Helier hospital is a perfect institution, but it is improving, and everyone there knows that it will be reviewed on an annual basis. That improvement must continue.

Paul Burstow: I entirely agree with the hon. Lady that there have been significant improvements at St. Helier since the Commission for Healthcare Audit and Inspection report. The improvements followed that report, however, not the star ratings.

Siobhain McDonagh: I disagree with the hon. Gentleman. People know that the hospital had a zero star rating. The rating was immediately understandable and one that people generally accepted. The then chief executive decided to resign and was replaced with another chief executive who achieved incredible improvements and has now been promoted. I wish every luck to the new chief executive in carrying on in the same way.
	St. Helier is far from perfect and it needs to continue to improve. I am glad that the star rating system is there to help it to continue that improvement. I should like to finish by quoting from a letter about St. Helier that I received today from a constituent:
	"I was admitted to the hospital two weeks ago as an emergency admission to A & E and then to both Ward C6 and then Beacon Ward. I was most impressed by the kindness of all members of staff during the day and nights, their attention to correct hygiene procedures at all times, and the doctors who with their regular visits make you feel special by keeping you informed in your progress. I would also like to thank the dinner and tea ladies and cleaning ladies and men, who were always cheerful and willing to help in any way they could. Words cannot express my gratitude to everyone involved in my recovery and their obvious pride in their work and their teamwork, which was second to none. Please pass on my thanks to everyone involved in my recovery."
	This is about people's health improvement, and the star ratings have led to Mrs. McNaughton having a much better experience at St. Helier than she would have done prior to 2000.

Angela Browning: I should like to pick up on the theme pursued by the hon. Member for Mitcham and Morden (Siobhain McDonagh). My very recent experience of what star ratings have done, and of the state of our NHS hospitals, has been quite appalling. I believe that the focus on nationally set targets skews the way in which decisions are made about resource allocation in hospitals in order to meet targets and to get the extra finance so as to go up the star ratings system.
	I want to make it clear that I am speaking about a one-star hospital not in my constituency but in the home counties, to which an elderly lady relative of mine was recently admitted. She was very frail and had a fractured neck of femur—a common problem incurred when elderly people fall. She was admitted to casualty and I was anxious that she should not have to wait on a trolley for a long time. I was pleasantly surprised, therefore, when she was admitted to a ward within a few hours. I was told that she would be operated on the next day. Anyone with any medical knowledge will know that it is important to operate on a fractured neck of femur within a maximum of 48 hours, whatever the person's state of health or age. As is the normal custom, my relative was designated nil by mouth, but she went on being nil by mouth for five days, until eventually I threatened to go to the press unless she was operated on.
	I shall not go into any more detail about the individuals concerned in this case because I am pursuing a formal complaint with the hospital concerned. The reason why I am raising it here is to point out that, in order to meet the elective surgery targets set by the Department of Health, that hospital has a long waiting list of former cases on an ongoing basis. That is where the skewing of targets and resources causes extreme detriment to patients. Hospital surgeons tell us that it is not uncommon for them to have 30 trauma cases waiting, but that their hospital management will not open up a second theatre over a weekend to deal not just with the existing backlog of trauma cases but with the increasing number of accident and emergency cases coming in. As someone who has worked in an operating theatre, I fully understand the dilemma of the doctors and nurses in our health service who, when faced with a road traffic accident admittance, for example, have to deal with some of those cases before they can deal with the fractured necks of femur or the trauma cases sitting on their wards.
	The one-star hospital in question here had met the Government's target of not having people sitting round in casualty for more than three hours. It had admitted the patient to a bed, but had not had the resources to deal with the number of trauma cases that such a catchment area naturally has. My investigations have shown that this is not a one-off. In fact, I intend to pursue the matter to find out just what the state of trauma surgery in our hospitals is, whether they have one star or three.
	Having been through that experience, when I hear Ministers talking about data, systems and civil servants, it all seems very remote from the day-to-day experiences of people up and down the country who are faced with a health service that, frankly, is not delivering. This is not just about what we used in the old days to call cold surgery—elective cases, as they are now called—painful though it is for people waiting to have a hip replaced. Of course we want those people to be treated as quickly as possible. When targets are introduced, they start to skew the service for others, for whom life and health are going to be critical. There is something seriously wrong with the target system that now exists, particularly in relation to surgical cases in hospitals.

Howard Stoate: I entirely share the hon. Lady's concern. It is completely unacceptable that an elderly lady with a fractured hip should wait five days for an operation, and I would welcome further information on how that was allowed to happen, and on what could be done to prevent it from happening again. This raises the important point, however, that unless we measure what is going on in our hospitals, we have no way of improving them. Does the hon. Lady not agree that the only way to ensure that the health service is as good for her constituents as I hope it is for mine is to ensure that the investment goes in to improve it year on year and that we introduce changes and improvements to ensure that the money is well spent and invested, and used directly to improve patient care. We must have information before we can measure those outcomes.

Angela Browning: I am not saying that performance indicators and information are unnecessary. They are important management tools in any function, and particularly so in the NHS. I am not complaining about that. I am saying that, when targets are set by Ministers in Whitehall, it restricts the flexibility that hospital clinicians and managers have at local level, in terms of what a hospital's priority should be on any given day or week. Therefore, in hospitals such as the one I have mentioned, which has a one-star rating—I hope that Members on both sides of the House, having heard my experience, will say, "No wonder it has a one-star rating"—where the real difficulty was that surgeons were asking to open up second theatres to deal with trauma and were being denied them by the management, the management clearly had to prioritise its resources and money to make sure that it met targets in elective surgery and other priorities that are not being decided at a local level. Meeting many of those targets is locked in to the star system, and we have heard arguments today about the funding that hospitals receive.
	Of course, nobody expects poor performance to be rewarded, but what choice is available to a patient who lives in one of those areas? It would be nice if all hospitals—in accordance with the experience of the hon. Member for Mitcham and Morden (Siobhain McDonagh)—were seeing an improvement. I have not seen an improvement, however, in a situation in which managers are told what their priorities should be by people who have no clinical responsibility. When we are dealing with real cases face to face rather than talking about statistics as we do in this place, and when real people whom we know and love are affected, that brings home much more clearly how wrong the current system is in terms of control from the centre that overrides what doctors believe should be the priority in a particular hospital. The hon. Member for Birmingham, Hall Green (Mr. McCabe) shakes his head, but when there are people who will die, and doctors know that they will die, doctors ask for second theatres to be opened. My experience when I worked in a theatre under the previous Labour Government was that such theatres were opened up. At weekends, there was always a standby team for a second theatre to be opened up. Things have not got better; they have got worse.

Phyllis Starkey: Obviously, it is difficult for us to discuss the case that the hon. Lady raises, as we are not privy to all the details. Does she accept, however, that it is not self-evident that targets were the problem, but that the hospital concerned either did not have adequate resources or was not managing its resources properly? Had the hospital made available resources for the case she mentioned, I presume that it would have had to take them away from another one. Targets relate to real clinical need, so that would have meant other people waiting for operations. The case that she raises does not therefore attack targets but points to the need for additional resources.

Angela Browning: In terms of prioritising resources for surgical cases in a general hospital, trauma cases would be high up, at the top of the list—they would have to come higher than elective surgery because they are life-and-death cases. In relation to the individual case that I described, it was not a one-off case: the hospital had a long trauma list that appeared to be ongoing, and apart from the case of which I have personal experience, 29 other people were in similar situations. In terms of resources and a surgical budget, priority must be given to the trauma surgical budget over the elective budget. If one is subject to elective budget targets, and to achieving stars by meeting elective targets, or to having financial penalties in the next financial year, as some hospitals have experienced, that is wrong. It is wrong not from a management or systems point of view but from the point of view of the people who live in that area and who are dependent on that one hospital, to which they go if they have an accident.
	If people have elective surgery, even under this Government, certain flexibilities exist whereby they can try to choose which hospital they go to and who operates on them. If they have an accident and are taken to hospital in an ambulance, they do not have a choice. What I am saying is that if people are taken in an ambulance to an accident and emergency department and they need surgery following that admission so that they are stuck with that one hospital, that area of surgery should be given high priority and should not be subject to problems that relate either to how the budget is spent in other areas or to the need to meet elective surgical targets.
	I wanted to raise this issue because I am worried about the number of deaths in this country as a result of fractured neck of femur, particularly among the elderly. I am concerned that elderly people who are admitted on that basis are shunted down the list purely on grounds of age. That is an area of health care that needs investigation, not just because of my personal experience but because I am concerned that this is a widespread problem throughout the country and needs to be addressed as a matter of urgency.

Stephen McCabe: The truth is that there are two parts to today's debate. The first part—the only one to which the hon. Member for South Suffolk (Mr. Yeo) referred—is the Tory agenda. It has none of the "I believe" and the "Be positive" in it. It says, "Get on the negative and hit it hard." The Tory party's strategy is to undermine the health service at every turn and at every opportunity, and it must persuade the public that the health service is failing. That is the only point at which any Tory policy begins to emerge.
	Coupled with that, we are starting to see a new trend in Tory performance. Yesterday, the shadow Secretary of State for Transport used the pilots' trade union as the bulwark for her argument. Today, the Tory health and education spokesman used the doctors' trade union spokesman—a gentleman whom I believe is a consultant at a one-star hospital, so, clearly, he has no vested interest—as the bulwark for his argument.
	The other part of the Tory agenda is clear. The Tory party is haunted by the sleaze that bedevilled the last Tory Government, so it has decided that the easiest way to defuse that is to apply to all politics and all politicians the taint that they cannot be trusted. Today, we heard a twin strategy to undermine and attack the health service at every opportunity, and to attack the people who work in it and who are doing their best to drive up standards and performance and to give the best care to those most in need—to attack, condemn and denigrate at every turn.
	Simultaneously, the Tories are attempting to persuade the public that the way to deal with sleaze is not to make the Tories account for what they did and for why so many of them ended up in the courts and jails but to say that all politicians are liars, that all politicians try to distort, and that all politicians try to manipulate solely for personal gain.

Peter Lilley: In his contemptible remarks, is the hon. Gentleman trying to assert that only Conservatives and all Conservatives are dishonourable?

Stephen McCabe: I am happy to give the right hon. Gentleman a list of former Conservative Cabinet Ministers and serious politicians who ended up in court and in jail. I am happy to assert that if that is what he wants. My point is that the Conservatives have a twin strategy: first, to undermine and denigrate the health service—

Peter Lilley: Will the hon. Gentleman answer my question? He has asserted by implication that all Conservatives, but only Conservatives, are dishonourable. Will he now withdraw that foul imputation?

Stephen McCabe: I think that the right hon. Gentleman has a hearing problem. I did not assert that at all. I asserted that the Conservative party has a problem with sleaze dating back to the previous Conservative Government, and its political strategy to try to deal with that is to try to smear everyone else. I repeat that. I am not surprised that he does not like to hear it, but it is unfortunately the case, and he will hear a lot more of it if the Conservatives persist in their current performance.

Mark Francois: Does the hon. Gentleman accept that the basic text for much of today's debate has been the article that appeared in the Health Service Journal, and which was produced by its own, well-respected journalists? Is he trying to tell the House that that publication is an organ of the Conservative party, because I am not aware that it is?

Stephen McCabe: I made no reference at all to the Health Service Journal, but I did refer to the motion before the House, and to the fact that the Opposition spokesman referred only to the first four lines of it.
	I want to turn to the second aspect of the debate, which is the effectiveness of indicators, the need for greater transparency and the question of whether the way in which trusts operate is distorted—a matter that the hon. Member for Tiverton and Honiton (Mrs. Browning) raised. I am not at all convinced that the indicators are ineffective. I would be the first to accept that they can always be improved, which probably explains why they have been revised at least three times already. As I understand it, acute trusts are currently using 44 indicators. Some 13 are the same as the originals, 23 are broadly similar and there are eight new ones. That has happened because in talking to the trusts and taking account of the other clinical governance exercises that have taken place, the Commission for Healthcare Audit and Inspection has been responding to demands for change. It has been told that some of the indicators are not particularly effective, are rather time-consuming in terms of the way in which the data are processed, and do not deliver that much. As a result, it has been asked whether they can be got rid of or changed, and whether other factors that have not been taken into account could be included. That seems a sensible approach.
	I am constantly told that the indicators are useless, but it is important to bear in mind what young and adult in-patients say about the quality of care, the level of safety and the degree of co-ordination. Cancelled operations are a good indicator, and clinical negligence is another important factor that I would want to know about if I was going to a local hospital. The number of deaths following heart bypass operations might also offer a reasonably good clue as to how the hospital in question is performing. One might also want to take into account deaths following non-elective surgical procedures. Emergency readmissions following discharge are also worth knowing about, as are readmissions following discharge in respect of fractured hips.

Howard Stoate: My hon. Friend makes a very important point. Opposition Members say that it is their policy to scrap star ratings, thereby denying us, presumably, the information that he has so eloquently given on these extremely important indicators. Such knowledge would certainly influence my choice of hospital if I needed an elective operation.

Stephen McCabe: My hon. Friend is absolutely right. I am not saying that the system is perfect. I have never heard a Minister say that it is perfect, and nor did the Secretary of State claim that today. What we are saying is that we have a method of measuring, and of giving trusts and the public an idea of what is happening. That is important.

Angela Browning: It is not possible to make a choice in respect of non-elective surgery, so what does someone do if they are in an ambulance following an accident and the hospital to which they are being taken for treatment is terrible?

Stephen McCabe: The hon. Lady knows as well as I do that, in that circumstance, the average individual would not be in much of a position to do anything. My point is that we have indicators that allow us to measure performance, and to try to drive it up.

Andrew Lansley: Will the hon. Gentleman give way?

Stephen McCabe: No, I have been very generous already.

Andrew Lansley: rose—

Stephen McCabe: As it is the hon. Gentleman, I shall give way.

Andrew Lansley: The hon. Gentleman has indeed been generous, and I am grateful to him for giving way again. I want to correct what might otherwise be a misapprehension on his and his colleagues' part. He asks us to look at the motion, but if he does so he will see that its purpose is to stop "excessive reliance" on indicators, not to remove the information that patients need. But star ratings are an essential part of that excessive reliance, and as my hon. Friend the Member for Tiverton and Honiton (Mrs. Browning) pointed out, they are part of a system of targets that leads to distortions.

Stephen McCabe: I am grateful for that intervention. If the Opposition spokesman had discussed the rest of the motion during his speech, rather than dwelling on the first four lines, perhaps we would not have needed that intervention.
	The indicators are owned by CHAI, which reports to Parliament, so they are hardly open to manipulation by Ministers. And what of the effect on trusts? We are told that the indicators distort the allocation of resources and inhibit the independence of professionals and managers. I asked my local acute trust how it makes use of them, and whether they in fact constitute an onerous chore. It gave a couple of examples that are worth pointing out. It examined the time involved in accident and emergency situations, and concluded that it had to change some of the doctors' practices. For example, more weekend work for consultants was mentioned. That may be a real drag in terms of time spent on the golf course, but sometimes such changes have to be made. It also examined some of the cancer indicators, and although it measured some progress, it discovered specific areas in which there were capacity problems. As a result, it knows that spending must be skewed to address that issue. Frankly, cancer sufferers will be delighted, rather than saddened, to hear that. Funnily enough, the trust also noticed that it has to do better in respect of people's complaints, an issue to which the hon. Member for Tiverton and Honiton referred earlier. It wants to deal with complaints openly and transparently.
	These indicators are not perfect, but they do give us and the public some indication of what is happening. In terms of their development, there is interaction between the trusts, the patients forums as they come on line, and CHAI. We also know that they are used in a practical way by good trusts that want to improve, in order to move matters forward. The choice is between sweeping that away or coming up with a credible alternative. When Opposition Members come up with a credible alternative, I shall listen to it seriously.

Stephen Dorrell: I want to begin by making it clear that I am in favour of the principle that better management of the health service, better care for patients and better use of resources will be achieved if we require health service institutions to publish evidence of how they are performing against key performance indicators. I embrace that principle wholeheartedly, and for some fairly conventional reasons. I do not believe it right that this public service should be managed in secret, and that the people who pay for it and use it should be unaware of its performance. Nor do I believe that special rules in this respect apply to the clinical professions. In respect of NHS institutions, it is just as important that evidence of clinical performance be published, as well as non-clinical performance. It would be strange if I thought any different, because as I said in an intervention on the Secretary of State, that was the route that we took when in government. It was my immediate predecessor as Secretary of State, my right hon. Friend for South-West Surrey (Virginia Bottomley), who introduced the principle. I developed it, and I share in the implied criticism offered by the current Secretary of State in respect of his predecessor, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), in that the policy was not developed during the years immediately after our leaving office.
	It is not the principle of the Government's requirement that the NHS publish evidence of its performance that is wrong; what is wrong is the way in which the Government develop that principle in practice. I want to go through some of the reasons why the Secretary of State finds himself in such deep water as a result of the story published just before Christmas by the Health Service Journal. The story is powerful evidence that the Government are failing in practice to pursue the good principle that the NHS should be seen to be accountable. Why are they so failing? The first fact that anybody introducing performance indicators has to understand is that if they are going to influence performance in the hospital quoted by my hon. Friend the Member for Tiverton and Honiton (Mrs. Browning), for example, the indicators against which the institution is to be judged must have a broad measure of support within the institution itself, and within the wider health community. That does not mean that every single person working in the health service has to accept every single indicator, but it certainly means that we cannot be content with a position in which only 15 per cent. of primary care trusts believe that the star indicators published last year were fair. If only 15 per cent. of those people believe that the star system is fair, that is powerful evidence that the Government are failing to deliver their policies in practice.
	Why is that the case? There are several reasons, some of which have already been mentioned, some of which have not. One that has already been referred to—and it is hugely important—is the point made by my hon. Friend the Member for Tiverton and Honiton that indicators must reflect the local circumstances of the community that the NHS trust seeks to serve. We have an absurdly over-centralised management system in the health service, when there should be much greater flexibility to allow local PCTs and the local community to set indicators that reflect the particular circumstances of the community that the institution seeks to serve. That is preferable to setting single blanket indicators that apply across the board—the one-size-fits-all approach, which does not work.
	The second principle that the Government violate was made crystal clear in the Secretary of State's speech. His central defence to the charge that the South Durham NHS trust indicators had been fixed for political reasons was, "Oh no, they haven't." He reminded the House that the negotiation continued four months after the end of the period ostensibly being measured. He said that the negotiation in July determined the star ratings of NHS trusts during the period ending in the previous March.
	It is a pretty basic rule of influencing performance by setting targets or measuring performance through indicators that the targets should be set at the beginning of the period in which one is seeking to influence performance, which allows people to respond to the incentives. If the hospital in the constituency of my hon. Friend the Member for Tiverton and Honiton sets, as it should, key performance indicators at the beginning of the period specifying that trauma patients should be treated within an acceptably short period of time—the maximum in that hospital was probably 48 or 24 hours—there is some chance that the hospital will manage its affairs to meet the target. However, if the key performance indicators are decided four months after the period has ended, it invites all the criticisms to which the Secretary of State has been subjected as a result of the Health Service Journal story about the South Durham trust.
	The first principle is that the indicators should be more local and the second is that they should be clear and set before the period that they are designed to influence starts. The third, of course, is that the detail of the targets themselves should be seen to be fair and reasonable, and to reflect a reasonable interpretation of both the efficient use of resources and clinical priorities.
	I cite one simple example from my own constituency in Leicestershire—the 12-hour trolley wait target for accident and emergency cases, which is wholly reasonable. I agree with the Government that people should not have to wait on trolleys for more than 12 hours in accident and emergency cases, but it is not surprising that Leicestershire acute hospitals trust finds it bizarre that a maximum of 10 patients in a year are being allowed to escape that target, because it applies as much to the neighbouring trust in Kettering, despite the fact that the Kettering trust treats only 20 per cent. of the the number of patients that are treated in the Leicestershire trust. One is therefore five times more likely to be caught in a 12-hour trolley wait in Kettering, which still achieves its target, than in the bigger trust in Leicestershire. That is an example of a target that is rightly viewed as bizarre in its effect. Targets must be local, clear and accepted as fair by those operating the system.
	The Secretary of State is operating a system that does not obey the simple rules of setting targets of accountability in order to affect NHS performance. It is not surprising that he has been subject to the criticism that he is fixing the system to accommodate the South Durham trust. That trust provides a good political anecdote, but it is also an important example because it attracts attention to inadequacies in the accountability mechanism for the health service.
	That example also illustrates a broader truth—this is my final point—that Whitehall hates accountability. When Ministers say to civil servants that it would be a good idea to set a series of indicators to judge the performance of a particular aspect of government in a clearly measurable way that is known in advance and makes the Government accountable to the public, the civil servant replies, in that hallowed phrase: "Minister, that is a brave policy, but it puts you at risk of an unhelpful statistic being published in the second week of an election campaign, and what would that do for your career?" What the civil servant really means in providing such paternal care for a Secretary of State's career is that it would not do much for his career as a civil servant if such a statistic were published in the second week of an election campaign.
	The whole issue of targets needs to be addressed more seriously in order to ensure that we enforce proper accepted accountability in the health service and for public services more generally. Unless and until we do so, our taxpayers and service users will have to continue to accept second-rate service because none of us will be allowed to know any better.

Phyllis Starkey: Before I begin, perhaps you, Mr. Deputy Speaker, could pass on to Mr. Speaker how helpful Back Benchers find the new arrangement with the digital countdown.
	Turning to the matter in hand, I was disappointed by the major part of the opening speech by the hon. Member for South Suffolk (Mr. Yeo), who indulged in—to inordinate length—a rather ludicrous conspiracy theory. I am pleased to say that it was effectively refuted by my right hon. Friend the Secretary of State and I do not intend to waste any more time on that matter.
	More interesting was the way in which the Opposition Front-Bench spokesman and the hon. Member for North-West Norfolk (Mr. Bellingham), who is no longer in his place, let the cat out of the bag regarding their attitude to performance indicators in general. I exempt from that criticism the right hon. Member for Charnwood (Mr. Dorrell), who made an extremely thoughtful contribution, though I take exception to his mathematical distortion in respect of the differences between the Kettering and Leicestershire trusts. However, I shall take that up with him outside the Chamber, as the matter is rather more complicated than warrants debate here.
	However, Conservative Front Bench Members and the hon. Member for North-West Norfolk demonstrated that the Conservatives are not just against, as it says in the Opposition motion, "excessive" reliance on performance indicators, but against all such indicators. That is an extraordinary line for the Conservative party to adopt. The NHS is a public service financed by public money. It is perfectly reasonable for it to be run in line with outcomes that the public require. That is what the performance indicators and, indeed, the NHS framework are designed to do. They are designed to set clear standards and outcomes. The frameworks are partly set by the various royal colleges, but also take into account the views of the public and of sufferers from diseases about how treatment should be shaped. The performance indicators are also clear and are designed to draw attention to the NHS services that the public feel are important. For example, people should not have to wait excessively for in-patient or out-patient services, accident and emergency services and others. It is perfectly reasonable that those performance indicators should be set by the Government, in consultation with the public. I cannot understand why the Conservatives object to that. Do they think that the Government should simply give the NHS and other public services money to spend as they wish, without interference? It is extraordinary that the Conservatives appear to suggest that the public should pay their taxes and buy a pig in a poke when it comes to public services.

Simon Burns: Rubbish.

Phyllis Starkey: Of course it is true that doctors must exercise their clinical judgment about specific treatments for patients. However, when the Conservatives were in charge of the NHS and doctors were allowed to set NHS priorities, a very low priority was often given to operations such as hip replacements—exactly the sort of elective orthopaedic operations to which the hon. Member for Tiverton and Honiton (Mrs. Browning) objected. The suspicion was that those operations were given a low priority because they are not very interesting to do. They are dead straightforward; one needs to be reasonably competent, but for surgeons it is much more interesting to concentrate on the big, challenging operations.
	However, every hon. Member knows that hip replacements are incredibly important to constituents. The problems that such operations resolve are not life threatening, although old people who have to wait for treatment are much more prone to die from other conditions. Delays in hip replacement operations can have an extremely detrimental effect on people's quality of life. That is one reason why it is very important to have performance indicators that reduce the waiting time for such operations.
	I return now to the point made by the hon. Member for Tiverton and Honiton. Did she raise the matter with the Member of Parliament representing the constituency in which the hospital is sited? The issues that she raised have a much wider importance than their effect on her relative, and I repeat that the question is one of resources and their proper management. The hospital in my area faces similar problems, and it has brought in French surgeons to work in operating theatres at weekends to clear some of the backlog. Our own surgeons were working so many hours that they could not be asked to do any more. I do not understand why the hospital to which the hon. Lady referred did not do the same, instead of blaming performance indicators.

Angela Browning: I want to clarify the record. I am more concerned about the waiting lists for trauma surgery than the waiting lists for elective hip surgery. My point was that if there are 30 people suffering from traumatic injuries, one of them might have a fractured neck of femur. That person might be required to wait five days for an operation, on a regimen of nil by mouth. It is wrong to put elective surgery ahead of that operation in order to meet a target. Finally, I assure the hon. Lady that I have raised the matter with the relevant Member of Parliament.

Phyllis Starkey: I think that the question is one of resources. The hospital concerned should have managed its resources better. It is not a matter of targets distorting provision, as it is also important to meet elective surgery targets.
	I find the general attack made on performance indicators by some Conservative Front-Bench Members extraordinary, especially given that they belong to the Conservative party. They would not expect businesses to operate without performance indicators, so I do not understand why they think that public services should do so. Moreover, those indicators are set in ways that the public clearly support.
	Do the Opposition object to specific targets? My hon. Friend the Member for Birmingham, Hall Green (Mr. McCabe), who has just left the Chamber, talked about some of the specific targets. It would be helpful if Opposition Members would say which targets they object to. Do they object to targets on waiting times, or on cancer death rates? Which targets would they get rid of, or do they want to get rid of them all?
	I turn now to my constituency, which has had a rather interesting experience with the star rating system. This year, the hospital and the PCT that serve my constituency, and the constituency of my hon. Friend the Member for Milton Keynes, North-East (Brian White), were zero rated. That zero rating was quite properly applied, as the hospital and the PCT failed to meet their budgets and to meet their waiting times and accident and emergency targets.
	They failed to meet those targets because of under capacity in the Milton Keynes general hospital, which is a direct inheritance of the years when the previous Conservative Government were in charge of the NHS. Milton Keynes is a growth area: its population has grown by between 2 per cent. and 3 per cent. a year since goodness knows when. However, in the 10 years preceding the election of the present Government, not one extra bed was provided at Milton Keynes general hospital. Clearly, the hospital suffered from under capacity in that time, and it has not caught up yet. This Government have been very generous in the funding that they have made available and the problem is not as bad as it used to be, but the hospital still suffers from under capacity. That is why it and the PCT were zero rated.
	That zero rating highlighted even more clearly a problem that I and my hon. Friend the Member for Milton Keynes, North-East had highlighted already in our frequent representations to Ministers. The Modernisation Agency has studied the general hospital and the PCT and has crawled all over everything that is being done. It has come to the view that there is very little more that the management could do to improve matters. It has confirmed that the problem is the result of under capacity and not poor management. As a result, the case that I and my hon. Friend have been making has been strengthened. We have presented it again to my right hon. Friend the Secretary of State, who was kind enough to meet us just before Christmas. We are both confident that my right hon. Friend will devote even more resources to the problem.
	The experience in Milton Keynes is therefore that the star rating system helps to make clear where a hospital or PCT is encountering problems. It is then possible for the PCT and the Department of Health to look into why those problems have arisen, and to address them.

Andrew Lansley: The hon. Lady says that the hospital in her constituency has a zero star rating. Does she accept that people consider that to be an expression by the Government of the quality of practice in the hospital? The hospital may have very good clinical practice, and she has said that the zero star rating is the result of under capacity. However, the star rating does not indicate whether the hospital is meeting its targets in terms of capacity; it is interpreted by people as a much wider expression of patient satisfaction. Patient satisfaction may be high if there is good clinical practice.

Phyllis Starkey: In Milton Keynes, hospital managers and workers, and members of the public, are well aware of what the problem is. I and my hon. Friend the Member for Milton Keynes, North-East have been in dialogue with the hospital management. We have made it very clear that we understand that the problems that have been encountered are not the result of poor performance by anybody working in the health service in Milton Keynes, but that they are the result of under capacity. We have also made that clear to the Government.
	Although everybody was very disappointed that the rating slipped from one star back to a zero star rating, we all knew that the problem was one of under capacity—and that my right hon. Friend the Secretary of State was aware of that too. People were confident that the problem would be tackled, because it was evident that only by dealing with under capacity would the hospital's performance be improved.
	I should add that matters have already improved in Milton Keynes. Since the star ratings were handed out, our clinical precision unit has opened. It has greatly relieved pressure on the A and E unit, and a story in my local press this week suggests that performance is now worth something like two stars rather than zero.
	Finally, I believe that the Government's commitment to a properly funded NHS is self-evident. However, greater public funding must always be coupled with clear direction through the use of performance indicators and the national service framework. In that way, the money that comes from people's taxes can be spent on improving outputs. That must also be coupled with a continued drive to modernise the way in which health services are delivered across the piece.
	I am surprised that the Conservatives appear not to go along with the approach of increased funding, modernisation and a sensible system of performance indicators. I agree with my colleagues that the Conservative Front-Bench spokesmen seek simply to denigrate the NHS to soften people up in order to return to the two-tier system that the previous Government were trying to introduce.

Archie Norman: I want to build on the excellent speech made by my right hon. Friend the Member for Charnwood (Mr. Dorrell). Those of us who want the NHS to succeed know that that success depends not on the number of targets that we can generate, or even what they are, but on the management calibre that we bring to it, the teamwork and involvement of clinicians in a common vision of what they can achieve, and a framework of motivation and discretion within which they may operate. That of course is where the whole question of the target-based framework starts to apply.
	Like other hon. Members, I do not believe that it is at all surprising that we have seen a proliferation in the number of targets. In fact, given that the Government have committed themselves to investing hugely greater resources in a substantially unreformed system with, in many cases, quite weak management, it is perfectly reasonable of them to say that they want to measure the outcomes. We must remember that in the early years, from 1999 to 2001, we had a 21 per cent. increase in expenditure for an increase in outputs of approximately 1.6 per cent. There are different ways of measuring output, but it is predictable that any Government faced with that sort of problem will want to establish greater clarity and measurement of performance.
	It is equally true, as Labour Members have said, that if we are ever to create any sort of internal market or sense of choice in the health service, the public need transparency of performance so that they may exercise whatever choices might be available in future. I am not, therefore, against the idea of targets or measures for their own sake. The issue is what part they should play in management and how they help build better-quality management with better clinical involvement as well as the right framework of motivation and commitment.
	The starting point is the sheer proliferation in the number of targets. It is quite unreasonable to generate so many targets that it is impossible for management to devote a reasonable amount of time to any single one of them. Chief executives of NHS trusts have 420 different targets to pursue. According to responses to my parliamentary questions, there are 151 performance indicators, up from 86 last year. That proliferation is a reflection of the preoccupation of Ministers and the Government with trying to impose control. Every time a new issue arises and every time something remotely threatening or critical of Government crosses their radar screen, it is extremely tempting to impose another target.
	The delusion is that a target will in any sense be a substitute for effective management.The target system is at risk of becoming a substitute for management. It is inevitable that it will be politicised; that is the nature of our system, and the episode with the South Durham Health Care NHS trust illustrates how a target-based system leaves Governments vulnerable to that. For management, that results in a vicious circle of demoralisation, a wedge between clinicians and management and a resulting decline in the calibre of people and resources available and rising costs in NHS administration.

Michael Jabez Foster: The hon. Gentleman has made it clear that he is not against all targets, but against the extent of the targets. Will he make it clear which particular targets he is against? Which does he believe to be irrelevant, and which should be discounted?

Archie Norman: The hon. Gentleman asks a perfectly reasonable question. It is obvious that removing any of the existing targets would be a difficult and sensitive problem. I put it to him, however, that if targets are to achieve any reasonable purpose, there is no point in having more of them than the chief executives and management of trusts can sensibly devote their time to. All that does is invite them to fail. It is inevitable that some trusts, even excellent ones, will underperform on some of the 420 different targets. As a result, the idea will be encouraged among the general public that the NHS is failing. I put it to Ministers that if they are sincere in their commitment to restoring public confidence in the NHS, and if they want to demonstrate that there is improvement, the first thing to address is the nature of the targets and whether they are giving the NHS a feasible or deliverable set of outcomes.
	No one should be deluded about the extent of the problem. By way of illustration, the British Medial Journal survey of clinical directors on 22 March last year found 60 per cent. responding that they do not have confidence in the management of their trusts. The reason is that we are increasingly driving a wedge between clinicians and management. Clinicians have very low regard for many administrators and feel that the targets, which put pressure on the administrators, are being imposed upon them.
	The evidence from all over the world of what succeeds in health management shows that it is top-calibre people and a common clinical vision. World-leading organisations, such as Kaiser Permanente in the United States, specialise in that. We need not more managers, but fewer. The Solucient study of the top 100 US hospitals found that they had 25 per cent. fewer managers and administrators than the average hospital.
	Yet the target-based culture will inevitably create more administration and management for no clinical purpose. The reality is that as long as we create huge numbers of targets, changing them every year, we will create a highly politicised system. While the Secretary of State acts, in effect, as the executive chairman of the NHS and is held accountable from day to day for the targets set, it is in the DNA of the system that we have that it is highly politicised, unless those targets are separated from the process of Government and there is a process of audit and verification that is seen to be independent.

John Reid: The hon. Gentleman is making an extremely interesting and constructive speech. I do not recognise the 400-odd targets to which he has referred; I estimate that there are about 62. It is arguable whether there are too many; that is a moot point. Certainly, however, we will have that many in future precisely for the reasons that the hon. Gentleman has given about the need for strong leadership and so on in the first instance, which perhaps is not there. A radical transformation requires a degree of—I will not call it autocracy—central direction of targets, which will increasingly disperse downwards as we go through the transformation. I agree with a great deal of what the hon. Gentleman says, though I do not necessarily agree with his numbers.

Archie Norman: I thank the Secretary of State for that. I do not want to engage now in a debate about the numbers, but would say only that they are quoted from responses to parliamentary questions that I have asked of his ministerial colleagues. We can engage in discussion about the figures at a later date.
	What I do put to the Secretary of State, and what I think is undeniable, is that there is a question of morale among the management of NHS trusts. The evidence for that is widespread, not least in the recent MORI survey showing that 62 per cent. of chief executives said, when asked about the target culture, that their role was becoming increasingly unattractive. Some 66 per cent. said that the NHS was losing its best leaders, and 69 per cent. said that negative perceptions now make it hard to attract clinicians into management, something which it is extremely important to achieve. The result is undoubtedly the loss of good managers and a failure to attract new management talent into the NHS, which is an increasingly difficult task when salaries are comparatively less competitive and perceptions are comparatively negative. Creating a management framework that is motivational for people, within which chief executives believe that they have the wherewithal to deliver their outcomes—a feasible set of outcomes—is absolutely crucial to the future stewardship of the health service and individual hospitals. Our system is simply not achieving that, and the target culture is one reason why.
	On top of that, I believe that the average life of a chief executive of an NHS trust is only 700 days in the job. One reason for that is that there have been substantial changes in management and mergers in the NHS, but it also results from the demoralisation and despair many managers feel about their ability to deliver in their role. At the same time, there has been a huge proliferation in the number of administrators. Ministers have failed to explain why the number of NHS administrators has increased. There may be many different reasons for that. One is that many of them are engaged in monitoring and responding to the scatter-gun approach to the proliferation of targets. I understand that the number of administrators may begin to reduce, but we have yet to see that. There was a huge increase—48 per cent.—between 1995 and 2001 compared with a 7.8 per cent. increase in the number of nursing and clinical staff.
	Faced with a crisis of management in the health service, according to my parliamentary questions—the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton) and I have had a dialogue on this—the Department has no knowledge of the career background of 60 per cent. of NHS chief executives. He has told me that that is not right, but it is the response that I received to my parliamentary questions. Even if the responses are incorrect, which I am prepared to accept, they must reflect the management priorities and the attitudes of Ministers.
	Just in case anyone thinks that targets do not affect attitudes within the NHS and among managers, I refer hon. Members to the article in the British Medical Journal on 20 December last year entitled "Snakes, ladders and spin", which states:
	"How to make a silk purse from a sow's ear—a comprehensive review of strategies to optimise data for corrupt managers and incompetent clinicians".
	Some of it is gripping, some is tongue in cheek, but it does say:
	"Surgeons' and hospitals' positions in league tables can make or break their reputations. They therefore need to learn how to present data in the best possible light."
	It refers to different ways of distorting the data and how managers and clinicians can represent themselves in the best possible light. It concludes by saying:
	"Performance managed healthcare settings encourage gaming and "creative accounting" of data. Creative accounting is driven by three dominant factor—attracting additional resources, meeting performance related targets, and improving positions in league tables".
	That is what administrators talk about. If Ministers can show that the target system is not distorting management priorities, they have to explain why everything in that article is wrong.
	Unless we get a different approach to management—one that concentrates more on developing quality leaders in the NHS; on getting better co-ordination between those leaders, managers and clinicians; on developing a common clinical vision of what is to be achieved; and on moving away from what is seen as a highly mechanical and one-size-fits-all approach to target setting—we will not get good value for money from the extra investment.

Andy Burnham: Comment has been made on an ex-Secretary of State for Health. I begin by commenting on an ex-shadow Secretary of State for Health. The hon. Member for Woodspring (Dr. Fox) may be gone, but it will be some time before Labour Members forget his disarming honesty about Tory health tactics. Fox by name, but certainly not by nature. There was nothing cunning or shrewd about his crude campaign to disparage the efforts of NHS staff and undermine the principle of a publicly funded collective health system.
	As the Daily Mirror revealed, the hon. Gentleman's tenure was dedicated to creating a four-point plan with the clear aim of fuelling public cynicism about the NHS. He fed the belief that the NHS is a financial black hole and that the people who work in it are incapable of improving it and of spending the public's money properly. Accordingly, the architect of that nasty plan has been rewarded with the chairmanship of the nasty party. What is revealing about the debate is that we now know for sure that the so-called new team on the Conservative Front Bench is sticking with that unsavoury doctrine. Part of it means undermining confidence in any mechanism that shows whether the NHS is improving. That is the essential context for the debate on the star rating system.
	At other times, the attack takes a different tack, but the fundamental point is the same. Conservatives complain of the productivity gap—that double-figure percentage increases in funding lead to single-figure increases in productivity. It is an argument that shamelessly skates over the fact that the outgoing Conservative Administration left the NHS bereft of the human and physical capital it needed, something to which my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) alluded. Given the time it takes to train clinical staff and build high-tech health facilities, there will inevitably be a lag before productivity levels rise again.
	What even the Conservatives cannot talk down are the black-and-white facts in the NHS chief executive's report published only in December. It shows solid progress and improvement that is a tribute to all concerned—Ministers, managers, nurses and doctors. It is hardly surprising if the public are unaware of the report's contents because it was largely dismissed by the media, presumably because the message was not what they wanted to hear. It reported substantial and sustained reductions in waiting times and waiting lists, a major increase in productivity and, interestingly, that the public now rely heavily on services dismissed as a gimmick by both main Opposition parties. In 2002–03, NHS Direct handled 6,319,000 calls and there were 1,373,000 visits to NHS walk-in centres. Now the Conservatives criticise the NHS star rating system in the same way. That is part of the Fox plan and it should be dismissed.
	Patients in our borough are served by the Wrightington, Wigan and Leigh NHS trust. Initially, it was awarded a two-star rating, but after a couple of years of steady improvement and management focus on the weaknesses identified by the performance indicators, last year it received a three-star rating. The achievement of three stars has boosted morale and staff were rightly rewarded with an extra day off. Morale has clearly improved—[Interruption.] The right hon. Member for Charnwood (Mr. Dorrell) laughs. He was a Minister in that Conservative Government. What a difference it must be for members of staff to work in a health service that is on the up and receiving investment. They can feel improvements in the air, unlike when they worked in the health service in 1996, when it was under his stewardship and cuts and decline were the order of the day. It must be a very different place to work. My thanks go to the staff of the Wrightington, Wigan and Leigh NHS trust, and in particular to Sheena Cumiskey, the chief executive, and Brian Strett, the chair.
	The trust is moving forward, with an application for foundation status having achieved three stars. That application is supported by the staff at our trust. Perhaps some of my hon. Friends have not given enough thought to that. It gives Leigh, the other town in the borough, a chance to shape the future of our own hospital, Leigh infirmary. I will call on local people to seize that opportunity to give our hospital a new future, given the powers that foundation status will, I hope, give us.
	It is not just our trust that has had a positive experience of the star rating system. There is substantial evidence that it has lifted performance across the NHS. Let us consider the evidence given to the Health Committee's inquiry on foundation trusts—of which the hon. Member for West Chelmsford (Mr. Burns) is a member. Mr. David Jackson, chief executive of the Bradford Hospitals NHS trust, said:
	"I can tell you that when we became a three-star trust—and I was very cynical about the whole process—the atmosphere in the hospital changed and people felt they had been recognised for the hard work and motivation and commitment and it had a very tangible beneficial effect."
	Mr. Nik Patten, deputy chief executive of the South Tees Hospitals NHS trust told us:
	"We missed three stars very marginally last year; our inpatient data was very, very good but our forms in two areas were slightly off the leading pace . . . We were disappointed that we did not get three stars . . . Having failed last year marginally, we want to achieve that three-star status."
	He agreed that it had energised the trust rather than demoralised it.
	The improvement that the chief executive report catalogues is a huge tribute to the work of my right hon. Friend the Member for Darlington (Mr. Milburn). His real achievement for patients and people in this country stands in stark contrast to the pettiness of the Opposition motion. That said, I want the Government to make more progress on one thing. Now that the NHS is back on its feet, I want our focus to switch to a sustained attack on entrenched ill health in some of our most deprived communities and to the health inequalities that still blight Britain. We have only scratched the surface. We need to tackle those huge structural and cultural problems. Ironically, that is a call for more political influence on the allocation of NHS resources.
	Last year Members, including me, lobbied hard for a change in the resource allocation formula that had previously been driven predominantly by factors such as old age. We succeeded. The Secretary of State listened and produced a formula that gives far more weight to deprivation and ill health as the guiding principles of resource allocation. However, in practice, we have yet to see the major shift in resources that the change in the formula accepts is necessary.
	Recently, I tabled a parliamentary question to the Department of Health to ask how far each primary care trust was from its target funding in the third year of the current spending review. The results are revealing. In some of the most affluent parts of the country, PCTs will be significantly over the target. Westminster will be £76 million over target. The figure will be £41 million in Wandsworth; £27 million in East Elmbridge and Mid Surrey; £18 million in Guildford and £19 million in Cambridge. However, in some of the most deprived parts of the country, with the most entrenched problems of ill health, the picture is reversed and PCTs are hugely under target. That is because although the formula now recognises the health needs of those communities, they do not yet have the resources. Central Liverpool is £26 million under target. The figure is £25 million for the Heart of Birmingham PCT; £24 million for Barking and Dagenham; £25 million for Easington; and in Ashton, Leigh and Wigan—my PCT—it is £12 million.
	I understand the rationale for the Department of Health's pace of change policy and the destabilising effects that could result from a rapid reallocation of NHS resources, but at a time of rising NHS funding the pace of change is far too slow. It is time to target new funding on the areas of the country where health is worst and that the Department itself accepts need significantly more resources.
	That focus should guide the Department's work in the medium term and it should be the bold agenda that guides a third-term Labour Government.

Richard Taylor: I begin by agreeing with the right hon. Member for Charnwood (Mr. Dorrell) and other speakers: I do not want the abolition of star ratings because they have an important part to play. However, I want to discuss their accuracy and appropriateness and some of their unwanted effects, and especially to press for more notice to be taken of the views of patients when NHS ratings are being drawn up. I hope that the presence of the Commission for Patient and Public Involvement in Health will help to ensure that the new Commission for Healthcare Audit and Inspection actually takes much more account of the views of patients.
	The assessment of quality in the NHS is a great interest of mine. Indeed, I held an extremely intimate Adjournment debate on the subject in Westminster Hall with a Health Minister on 10 June. I shall not go over the points that I made as they are recorded in Hansard, but I want to draw the House's attention to the balanced scorecard approach, to which the Secretary of State for Health has already referred, as that seems to be the most opaque method of assessing scores in a process that is supposed to be transparent and open to everybody.
	I argued that the people of whom it is most important to take account when establishing star ratings were being neglected. They are, of course, the recipients of health care—the patients—and its providers, the nurses and doctors. I shall not repeat what I said at that debate, but my views on the accuracy of the star ratings were borne out by the Audit Commission's report, "Achieving the NHS Plan", which concluded that the number of stars related only weakly to performance and management adequacy. The commission gave the stark illustration of a trust awarded two stars, yet from the detailed knowledge of the commission's local auditors it described that trust as "failing".
	I want to discuss the appropriateness of the current performance indicators and some of the possible unwanted effects of the system. As other hon. Members have pointed out, the indicators are incredibly important; the ratings carry rewards and foundation trust status. As an aside, it is no wonder that staff who are about to receive foundation status welcome it—it brings rewards. However, that high importance can bring risks. The Royal College of Nursing, in its submission to the Public Administration Committee's inquiry into targets, pointed out that there is a risk of influencing staff behaviour away from the best interests of patient care. A further risk is that to meet the target for seeing out-patients some trusts see more new patients at the cost of making essential follow-ups.
	Trusts may look for ways around the targets. Examples from accident and emergency departments have received much publicity: trolleys are converted to beds, waiting areas in other departments are used for patients, and there are queues of ambulances outside. Such cases have been well rehearsed in the past.
	The wait for out-patients begins only when the general practitioner's referral letter is logged in. That logging in may be delayed or, even worse, the letters may be lost. I have just received a letter from a constituent whose first delay occurred because the appointment letter was lost. A subsequent letter, in which he expected to be given a date for his appointment, stated:
	"Now you are on the outpatient waiting list to see Dr. X . . . the current waiting time is approximately 18 weeks . . . We will contact you about 4 weeks before the anticipated appointment time."
	It appears that there is a waiting list for the waiting list. Does the Minister admit that that is happening and is the practice widespread?
	Another risk is the cancellation of admissions for elective surgery for non-clinical reasons. What are the rules about that? Cancellation on the day of the operation is obviously counted, but can the trust avoid the stigma of cancellation by not recording it if it occurs earlier than that?
	An example of the inappropriateness of one existing target was published last August in the Journal of the Royal Society of Medicine. Urologists at Medway Maritime hospital considered the effects of the two-week rule for seeing patients with suspected urological cancers. They found that although it achieved more rapid times for seeing patients it had no effect at all on the interval between referral and receiving definitive treatment. There were delays for scans, X-rays, and operating theatre time. I understand that the Government have spotted that problem and that by the end of 2005 the target for all cancer treatment will be two months from urgent referral to actual treatment. Sadly, that is a long way away for patients today and I wish it could be sooner, although obviously it is an improvement.
	My quandary today is which way to vote. There are valid points in the Opposition motion, but there are also valid points in the Government amendment. I shall almost certainly take the step that only I am allowed to take and vote for both the amendment and the motion. I cannot see that there is anything mutually exclusive in either. I hope that when the Minister responds to the debate he will not attack the Conservative Opposition politically, as has occurred so often in the past during questions and debates—even Mr. Speaker has referred to the matter—by hiding behind their refusal to vote for more money for the NHS, rather than actually answering the questions.
	As I have said, I am not arguing for the abandonment of star ratings—I am merely arguing for greater reliability, greater local relevance, a greater impact of staff and patients' views and, above all, a greater emphasis on outcomes.
	Professor Alan Maynard, director of the health policy group at York university, wrote recently in the British Journal of Health Care Management
	"Whether spending more or doing more improves population health is sometimes asserted, but never measured systematically and demonstrated. Ignorance is bliss, no doubt, for decision-makers in Whitehall."

Howard Stoate: I shall be reasonably brief, as others wish to speak.
	I am very pleased that we are having this debate, because Members on both sides of the House are finding it useful. I am also pleased that the Secretary of State was able to explain how the star ratings are evolving, and how the indicators are changing year on year. It was reassuring to hear about the transparency of the system, and to learn that patients' involvement and experience were at the forefront, so that the patients could see that they were playing a part in the performance of hospitals.
	The facts are stark. The Government are putting record amounts of money into the health service: no one could deny that. It is important, however, to ensure that the investment is not wasted but is used to make genuine improvements in patient care. There is the rub: it is impossible to know how well investment is doing unless there is a coherent way of measuring outcomes.
	I do not want to dwell on this for too long, because many Members on both sides of the House have rehearsed the same arguments, but we obviously need a robust and coherent system of measurement to ensure that we are using money wisely—that it is targeted where it is needed most, and that we see genuine improvements in outcomes.
	The hon. Member for Tiverton and Honiton (Mrs. Browning) told a harrowing story of a patient who had suffered trauma. That is clearly unacceptable. Anyone experiencing such trauma will have a significant chance of experiencing long-term ill health and possibly early death if it is not treated quickly. I would certainly consider it unacceptable if people waited for five days for a similar operation at my local hospital. Without transparency, though, we do not know what is going on in our hospitals.
	My local trust, the Dartford and Gravesham NHS trust, opened one of the first new hospitals under the private finance initiative following this Government's election. The fantastic new building won various design awards. Size was always going to be a problem—the hospital was never going to be large enough for an expanding population in a part of north-west Kent that is experiencing huge growth—and it soon became clear that the Government's expectations were not being met. I received complaint after complaint. Operations were being cancelled, and people were waiting on trolleys in accident and emergency for unacceptable periods.
	Many factors were blamed for the problems in the early days. Some people said that there was too much management; others claimed that it was the wrong sort of management, or that the number of beds was wrong. The hospital received a zero star rating. Then, however, there was a change of culture: we appointed a new manager, Sue Jennings, who brought in a new management team. Something very radical then happened. There were no additional beds, and there was no reduction in the number of managers, but within a year of Sue Jennings's arrival the hospital had one star and the following year it had three.
	The effect on morale has been dramatic. When I walk into the hospital I see that everyone is smiling. Patients are smiling, staff are smiling, and the porters welcome those who enter with a spring in their step. That change in the culture is itself driving improvements and innovations, and genuinely improving patients' experience. It is almost impossible to describe the enormous improvements that have been made. I am not saying that everything is perfect, but that change in the culture has taken place—not because of huge expansion or a radical change in the number of managers, but simply because beds are being managed more effectively by more efficient managers.
	The only way in which we can objectively tell that such things are happening is through performance indicators such as the star rating system. The proof of the pudding is in the eating. The number of complaints I receive has fallen to almost zero, and the number of letters I receive from constituents saying, "I had a really good experience in the hospital," has increased dramatically. That is not accidental; it is due to the enormous amount of work put in by all the trust's staff. The whole situation has been radically improved by the fact that performance indicators enable staff and others to see how much the trust has improved, and how the culture of the hospital has changed.
	I would counsel strongly against the assumption that a sudden increase in the number of beds, or a sudden change in the number of managers, can make a massive difference. It cannot; we are talking about a change in culture, and the ability to demonstrate how much a hospital has improved.
	Let me give a classic example. When the hospital first opened and was clearly not doing particularly well, people would come to my surgery and say, "The Government are failing: the hospital is no good." I would say, "Look at the extra money that is going in." They would respond, "The extra money is making no difference. I am still having to wait for 12 hours on a trolley, or to wait for three months for an out-patient appointment. My operation has been cancelled. Your money is not doing any good." It was very difficult to persuade people that Government investment was making a difference. Now I can say, "Look at the performance indicators. Look at how the hospital has come on in the last couple of years"—and they now say, "Yes, I see that the money is beginning to make a difference. It is beginning to produce the improvements we have been demanding for the last few years."
	Debates like this are important because they give us an opportunity to air differences of opinion and to share our experiences. It is also important that our constituents can see what is going on in their hospitals, and ensure that what we hope to achieve is being achieved.
	The message is clear: the Government must go on investing in the health service as it is now. We shall not see an end to five-day waits for trauma surgery unless hospitals receive more investment, but it is clear that if hospitals do not use money effectively and have no effective measures to compare their performance with performances elsewhere in the region and the country as a whole, and with national standards, we shall not see the best results. There is no point in every hospital's reinventing the wheel. What is most important is for hospitals to take best practice from parts of the country where the system is clearly working, and use it to model their own performance. They will not necessarily perform in exactly the same way, because different local circumstances will require different approaches. But the only way in which to ensure that best practice is adopted throughout the country is to provide robust performance indicators that can be reproduced, so that we can genuinely compare like with like on a national basis.
	I am very pleased that my hospital has improved so much, and I am sure that other Members can recount similar stories. As long as the Government's money is invested and as long as it is spent wisely, everyone—particularly patients and NHS staff—will reap the rewards.

Peter Lilley: It is a great privilege to follow the very constructive contribution from the hon. Member for Dartford (Dr. Stoate), which had more in common with the contributions from my hon. Friends the Members for Tiverton and Honiton (Mrs. Browning) and for Tunbridge Wells (Mr. Norman) and my right hon. Friend the Member for Charnwood (Mr. Dorrell) than with that made from his own Front Bench.
	The key question underlying the debate on the health service today is why, despite the superb dedication of NHS staff, the huge increase in taxpayers' money going into the health service has not resulted in a commensurate increase and improvement in clinical services. In a nutshell, the reason is that those resources are allocated by a system that is highly centralised and micro-managed from the centre and where the management is driven by the desire for media manipulation and good headlines in the press tomorrow. Perhaps I can give some concrete examples of how that obsession with media manipulation and micro-management at the centre results in, at best, waste and, at worst, the undermining of clinical standards and, invariably, staff morale.
	The Government announced a waiting list initiative. They got a good headline. They announced a waiting list budget for each hospital—another good headline. They announced that each hospital should have a waiting list manager—a third good headline. What does that mean in practice? Well, in hospital A—I am not at liberty to reveal which hospital that is, but it is not in my constituency—the waiting list manager used his waiting list budget to meet his waiting list target by employing locum surgeons on Sundays, at much extra expense, but from his extra budget, to operate on people on the waiting list. That seems a good idea—expensive, but on first sight, it would reduce the waiting lists. Unfortunately, sterilisation teams are not employed on those Sundays, so all the equipment needs sterilising by the end of Sunday. Come Monday, no operation can be performed until late in the day, when all the equipment has been sterilised, but that is part of a different budget, so it does not matter. So a huge amount of money has been wasted for no extra improvement or no reduction in the waiting list. That is waste, but the result can be much worse than waste.
	In the same hospital, one of the senior consultants had made major advances in reducing infection—I shall refer to that problem again in a minute—by having a dedicated ward where people went after open-wound surgery. No one with an infection was allowed on the ward. But the waiting list manager, up against his waiting list target, had some people on the list who would go over the target by just a few extra days, so the senior consultant found that they were plonked on his ward. Some of them had bowel infections—one even has MRSA—so he said that he was not prepared to operate with those infections in the feeder ward for his operating theatre. He was told that he had to, because he had to meet his targets. He said, "Well, I will if you insist." He told his patients that they could be operated on if they would first sign a disclaimer, which they would be wise to do only if they were feeling suicidal, so no operations were carried out that day. More waste, and possibly a risk to people's lives as a result of a target-driven culture in the health service. So that is what the Government's policies mean in concrete terms, and those are not isolated examples.
	Patients are not interested in targets; they want to know that, when they go for treatment in hospital, they will come out healthier than when they came in. Sadly, we have a system where nearly one in 10 patients who go into hospital acquire an infection that they did not have before they went in. According to the National Audit Office, between 5,000 and 20,000 people die of superbug infections that they get in hospitals. The European Union says that the situation is worse in our hospitals than in any other country in Europe and getting worse faster in this country than elsewhere in Europe.
	When that first became a matter for public concern, the Government's response was to set up a system of traffic light indicators for hospital cleanliness: red for not so clean, amber for okay and green for fine. Unfortunately, they then discovered that, of the 20 hospitals with the highest level of MRSA superbug infection in the country, they had rated 15 green, five amber and none red. So they have naturally kept quiet about that expensive, time-consuming, costly and bureaucratic initiative for some while.
	I managed to raise the issue with the Prime Minister recently, asking him why we were fighting and losing that biological war in our hospitals. He said that I should not discuss negative aspects of NHS hospitals, but all hon. Members have to raise those matters and should continue to do so until our record is not the worst but the best in Europe. I will do so particularly because I had a hospital with one of the highest levels of MRSA infection serving my constituents. I am glad to say—I pay tribute to it—that it has halved that level during the past year, which shows that it can be done and that improvements can be made.
	A few days after I raised the issue with the Prime Minister, the Secretary of State—I regret that he is not here—announced with great fanfare a new initiative to deal with superbugs. There were headlines in all the newspapers. I asked whether he would make a statement about that new initiative and those new policies in Parliament. He wrote back to me, saying:
	"For the record, the press notice last Friday did not announce any new policy."
	The press statement actually says:
	"Mr. Reid gave his backing to wide-ranging proposals . . . which seek to revolutionise the way potential infections are handled in hospitals"
	involving,
	"new rules . . . a new system . . . a new drive . . . new plans".
	Apparently not new policies, however. It may well be that the Minister is happy to deceive the newspapers. I am certainly not accusing him of deceiving the House—I am accusing him of telling the truth to the House by saying that he does not have new policies to deal with an issue on which he should have new policies.
	In following this situation, I have done more than 20 radio and media interviews with consultants and people from the Academy for Infection Management. They have proposals to deal better with the problem, so why are the Government not giving them serious consideration? I have received many e-mails from consultants and doctors throughout the country pointing out what is happening and saying that solving the problem does not require large expenditure. The solution requires, above all, a transfer of responsibility back from management and bureaucracy to local clinical people. If that were successfully adhered to, it would save massive amounts, but it is not allowed because of the target-driven culture.
	One e-mail I received said:
	"We have managed to keep MRSA out of our rehabilitation unit by a combination of pre-screening, rigorous hygiene and vigorous treatment . . . However, we have been put under pressure to relax our criteria because they delay transfers".
	It says that there is a target
	"to move people out of casualty departments within a set time",
	so targets are putting pressure on the person who wrote the e-mail to undermine the clinical standards that were saving lives. The issue is important and I am sorry that the Secretary of State is not in the Chamber to tell us why he has no policies to deal with something that is killing thousands of our constituents. I hope that the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), who will wind up the debate, will tackle the problem more seriously than his colleagues have so far.

Adrian Bailey: In the few moments available to me I shall single out one or two of the points that I wish to make. I had a sense of déjà vu when I read the motion, because the substantive issues have been debated fairly comprehensively before. I took part in a debate on performance indicators and targets in October last year and, of course, the South Durham health care trust has been the subject of several questions in the Chamber, which have been adequately dealt with on each occasion. I can only deduce that the official Opposition's tactic is to reiterate a specific line of attack in the hope that constant denigration of, and carping about, performance indicators, targets and star ratings will somehow mask the huge improvements in the output of the NHS that are a result of Labour's investment in it.
	Conservative Members do not want to talk about the real issues that affect people's everyday lives, such as the length of time that they wait before they see their general practitioner or go into hospital for an operation, the number of people on waiting lists or the time that they have to spend in accident and emergency departments. Conservative Members do not want to discuss those points because they know that all the evidence from the indicators shows that the investment that Labour puts into the NHS is paying dividends and that the public appreciate that. They know that the NHS is the most popular service in the country—a service that not only improves the quality of life of millions of people but increases the length of their lives.
	A publicly funded service that is free at the point of delivery encapsulates Labour's values through and through. Conservative Members realise that if people appreciate that the principles that underpin the NHS pay dividends, they will support Labour at the next general election. They will therefore do everything in their political power to denigrate the service and hide the reality of the situation. In short, the motion is a politically motivated attack that is not rooted in the reality of people's everyday experience of the NHS, but designed to mask that reality in the interests of short-term political dividends for the Conservative party.

Andrew Lansley: In some respects, this has been an enlightening debate, but not in others. Conservative Members have shed considerable light on performance indicators, the way in which performance should be measured, the excessive nature of performance indicators and Government requirements for information, and the distortion of clinical priorities in the NHS and the severe consequences of the transfer of performance measurement to a system of centrally determined targets. My hon. Friends made excellent contributions, which reflected their experience in senior positions, both in government and in the private sector, and thus had a strong bearing on the way in which performance management should be conducted in large organisations. Their contributions also reflected their personal experience and the experience of real people.
	The hon. Member for Sutton and Cheam (Mr. Burstow) took up some of the forceful points made by my hon. Friend the Member for South Suffolk (Mr. Yeo) in his opening speech, but also raised the issue of Basildon and Thurrock. Can the Minister explain why, if the failure of the star ratings for Basildon and Thurrock was connected to patient surveys and patients' experience, the exclusion of catering, information technology and management criteria led to an increase in those ratings? The hon. Member for Sutton and Cheam referred to the excessive requests for information from the Government. The NHS Confederation produced a report just last month based on the experience of Manchester hospitals in which it said that there had been
	"a considerable increase in often unco-ordinated ad hoc requests . . . The quality of data provided at very short notice will be poor . . . Demands from the centre have often been poorly defined and do not always ask the right question . . . Information is requested without checking whether it already exists, leading to duplication."
	The confederation also says that
	"there is a lack of feedback on how information is used."
	As has been said, those hospitals concluded that more than half of the information requests that they received were not perceived to be useful for the management of the trust.
	That brings me to a point made by my right hon. Friend the Member for Charnwood (Mr. Dorrell). If a system of performance management, information gathering and data collection is to be devised within a large organisation, it should meet the trust's priorities. If we are serious about the devolution of management in the NHS—and Conservative Members are—priorities should be determined locally, so the system of performance of management should be devised locally and not centrally imposed. My hon. Friend the Member for Tiverton and Honiton (Mrs. Browning) spoke about the experience of real people in the NHS, which, as the hon. Member for Dartford (Dr. Stoate) rightly said, we should take to heart and acknowledge. I am sorry that my hon. Friend's speech was followed by that of the hon. Member for Birmingham, Hall Green (Mr. McCabe), which did not reflect the experience of real people in the NHS. I do not think that the hon. Member for Milton Keynes, South-West (Dr. Starkey) is aware of what is happening in the NHS. She said that everyone in her hospital in Milton Keynes agreed that there was a problem but she went on to say that they needed the star-rating system to tell what it was. There are two three-star hospitals in my constituency—Addenbrooke's, which has been a three-star hospital from the outset, and Papworth, which has been one since 2002. We are a fast-growing area, and have experienced pressures on capacity, but those hospitals have retained their three-star rating. The reasons for that were touched on by the hon. Member for Dartford who, as my right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) said, made a speech in keeping with Conservative philosophy.
	It is a matter of culture. It is about delivering in the NHS, which is not happening. Star ratings are not needed in order to deliver. We in South Cambridgeshire knew that Addenbrooke's hospital and Papworth hospital were excellent hospitals before the star rating system. I trust that the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), visited those hospitals yesterday and discovered that for himself.
	If we are to have transparency and accountability in the NHS, as I hope we will, the priorities that are determined locally must be reflected in performance management and in indicators that are accessible to the public. As my hon. Friend the Member for Tunbridge Wells (Mr. Norman) rightly said at the outset of his speech, if we are to implement a system of choice for patients, that requires transparency in performance. Indeed, that is our philosophy. We have got used to Labour Back Benchers and the Government misrepresenting the policies of the Conservative party. Most of the speeches made from the Government Benches suggested that Conservative oppose performance indicators.
	We are not opposed to performance indicators. We are opposed to excessive requests for information and excessive reliance on performance indicators. We are opposed to the imposition of performance indicators from the centre, rather than indicators derived from local priorities. We are particularly opposed to a system of targets and star ratings leading to a system of rewards and penalties for those who work in the NHS, which is determined from the centre and which, in the case set out in the motion, could be open to manipulation, as my hon. Friend the Member for South Suffolk said, by those at the centre, particularly Ministers.
	That is not a criticism of civil servants; it never was. The Secretary of State rightly defended civil servants. We are defending civil servants by seeking to expose the ministerial interference in the system. Many in the NHS are sceptical of the credibility of the star rating system. That system will be further undermined by the fact that they can now see an instance where it appeared open to ministerial interference.
	That brings us back to the case at the heart of the debate. My hon. Friend the Member for South Suffolk asked some questions of the Secretary of State, but he did not get many answers. The Secretary of State did not explain why the Prime Minister has neglected to reply to my hon. Friend's letter. It is all very well replying to my hon. Friend the Member for Woodspring (Dr. Fox), but that and the letter from the permanent secretary have served only to raise more questions than they answer.
	The Secretary of State relied on a series of changes over the years, but that does not explain why, if the system is changing and has changed last year and this year in the absence of ministerial involvement, ministerial involvement was so necessary in July 2002 to introduce the star rating system. The truth, I suspect, is that Ministers have been taken out of the star rating system in subsequent years, not least because of the interference in July 2002.
	Let me ask a question to which the Minister can reply in his winding-up speech. If it was necessary to drop two criteria—access to catering facilities and information management and technology—because the data were poor, were they dropped before 12 July 2002 or after? When the head of the performance development unit wrote to the Secretary of State, he made it clear that the process of consultation had already taken place. He stated:
	"Unfortunately, even if time allowed it, further revisions to the methodology to promote these trusts"—
	that is, the so-called high-profile trusts—
	"would inevitably lead to other individual results we had not expected, as well as making the scoring system more complicated."
	Responding to the request from the Secretary of State, the head of performance development wrote:
	"Alterations to the methodology have been made".
	The Minister of State said from a sedentary position that there had been no changes to the methodology, but the head of the performance development unit clearly said that there were. He went on to say that those resulted in
	"the changes to individual trusts that were requested."
	This was not some objective process derived from consultation with trusts and CHAI. It was in response to the Secretary of State's request. The head of the performance development unit went on to say:
	"This makes the scoring methodology more difficult to explain and less transparent."
	The Government's amendment refers to transparency. We all need transparency in the decision-making process, but it was perfectly clear that, as a result of the former Secretary of State's intervention, the system was made more difficult to explain and less transparent. Why did that happen? We need answers, and the Government have not given them to us.

John Hutton: This has turned out to be something of a surprising debate. It rapidly recovered from the low point that it reached after the contribution of the hon. Member for South Suffolk (Mr. Yeo) and turned into a high-powered, almost policy wonk-style seminar about the virtues and merits of performance assessment, performance indicators and the use of targets. I do not think that that was quite the intention behind the Opposition motion, but the debate was interesting none the less and I should like to return to some of the contributions that have been made.
	The other reason why the debate was surprising is that, when I was preparing for it, with some trepidation, I thought that the Opposition would set loose on the Government some of their Back-Bench parliamentary Rottweilers. Instead, to be fair to them, we heard some high-powered contributions from the Opposition Benches, as we did from the Labour Benches. We heard from two former Secretaries of State, a former Minister and a leading member of the former Tory shadow Cabinet. The right hon. Member for Charnwood (Mr. Dorrell) usually speaks a great deal of sense about the national health service, and he did so again today. Many Labour Members would want to agree with much of what he said, but his problem is that no one on the Conservative Front Bench looked too chuffed with what he had to say.
	The Tory motion has two components. There is a sort of puerile bit of old crap at the beginning, if I can use that as a parliamentary expression, or a puerile reference to my right hon. Friend the Member for Darlington (Mr. Milburn). It also has a second section dealing with the use of performance indicators. Not a single Conservative Back Bencher referred to the first part of the motion. I know perfectly well why: they recognised that there was not a shred of substance in any of the allegations that the hon. Member for South Suffolk brought before the House today.
	I congratulate my hon. Friends the Members for Mitcham and Morden (Siobhain McDonagh) and for Birmingham, Hall Green (Mr. McCabe), who spoke well and certainly rattled Opposition Members, and my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey), who also spoke well. My hon. Friend the Member for Leigh (Andy Burnham) made some important points about the funding formula. He will know that my right hon. Friend the Secretary of State is aware of the issues and is considering them very seriously. My hon. Friends the Members for Dartford (Dr. Stoate) and for West Bromwich, West (Mr. Bailey) hit the nail entirely on the head in their analysis of what lay behind the motion.
	I want to congratulate the hon. Member for Tiverton and Honiton (Mrs. Browning) on her remarks as well. She was right to express her concern about the treatment of one of her relatives, and if she is prepared to write to me about the matter, I shall be very happy to look into it. I interpreted her remarks, perhaps wrongly, as largely an appeal for additional resources for the national health service. With the best will in the world, I do not think that she is in the best position to advance that sort of argument to the House.

Angela Browning: Just for the record, I was not asking for more money, but talking about the way in which resources have to be allocated to meet targets instead of trauma cases.

John Hutton: The hon. Lady's comments certainly came across as an appeal for extra resources. I am grateful for her clarification.
	The hon. Member for Tunbridge Wells (Mr. Norman) spoke very well and made a number of very important points. He will know that I agree with much of what he has to say about management in the national health service. I look forward to further contributions from him.
	Perhaps I should not say this to the hon. Member for Wyre Forest (Dr. Taylor), who flummoxed us all by saying that he was going to vote both for and against the motion, but I do not think that he can do that. If he votes for the amendment, he will be seeking to delete the words of the motion and inserting words proposed by my right hon. Friends. He is welcome to do that, but it will be rather difficult for him to vote against it 10 minutes later.
	The right hon. Member for Hitchin and Harpenden (Mr. Lilley) made a very important contribution about hospital-acquired infections. We certainly want to deal with that issue. Of course, it is the responsibility of the chief medical officer, and he is taking forward work in that regard.
	The hon. Member for Sutton and Cheam (Mr. Burstow) made several observations about the performance assessment framework, as did the hon. Member for South Cambridgeshire (Mr. Lansley), who said—this was a surprise to us, given everything that the hon. Member for Woodspring (Dr. Fox) has said in the past—that the Conservatives are not opposed to a national set of performance indicators. He provided the helpful clarification that although he was not against those indicators, he did not want anyone to rely on them too much. That is not a terribly sensible position for him and his party to adopt—perhaps we can look forward to further clarification of exactly what he means by it.
	The hon. Member for Sutton and Cheam raised several issues that I shall try to deal with. He expressed his concerns about the 2003 star ratings and whether there had been any inappropriate ministerial interference. I quote to him what Deirdre Hine, the chairman of the Commission for Health Improvement, said on 16 July:
	"The targets and many of the indicators were set by the Department of Health but we have compiled the ratings this year. I would reiterate that there has been no pressure from ministers and these have been produced absolutely independently."
	I hope that that deals with the hon. Gentleman's point.
	The hon. Gentleman asked whether the final methodology that underpinned the eventual selection of performance indicators in July 2002 would be published. It was published on the same day as the performance indicators themselves—that is, nearly 18 months ago.
	The debate has, predictably, generated a lot of heat, but very little light has emerged from any Conservative Front Benchers. I should therefore like to start by concentrating on the facts, not the hyperbole. Let us be clear about those facts. My right hon. Friend the Member for Darlington raised questions about the publications of the NHS performance ratings for 2002, and he was absolutely right to do so—any Secretary of State would have done precisely the same thing. At that time, the Department was responsible for the preparation and publications of those ratings, and my right hon. Friend was, rightly, accountable to this House for the work that was being done. Moreover, it was the first time that comparisons with a previous set of ratings were going to be possible, so it was entirely appropriate that he should be satisfied that the final assessments were fair and accurate, as some trusts stood to lose stars.
	Most importantly, my right hon. Friend, in raising the questions that he did, was voicing the very same concerns about the 2002 ratings that had been expressed by NHS trusts. A significant number of NHS organisations—estimated at the time to be close to be half all those who had made representations during the ratification process—expressed concern about the inclusion of data from two performance indicators. The data on both were unreliable because there was confusion about what was being measured. That was the view of officials, who also advised that including the information from those two indicators in the final ratings could not be justified. The exclusion of the data from those two indicators was the sole reason why the South Durham NHS trust retained its three-star rating.
	The two performance indicators dealt with access by doctors to the internet and access by patients to 24-hour catering facilities. Neither of those indicators, on any reasonable measurement, can be said to be so important that it should have been included in the final ratings, as neither was central to shedding light on NHS trust performance. That is why they were not used in 2002 and why neither was used in subsequent performance assessment exercises.
	The hon. Member for Woodspring has repeatedly complained about the inclusion of such non-clinical data in NHS performance ratings. Far from criticising the actions of my right hon. Friend the Member for Darlington, as the hon. Member for South Suffolk chose to, he and his colleagues should welcome the fact that these two performance indicators were dropped from the 2002 ratings. Perhaps that welcome is being saved for another occasion, but I somehow doubt it.
	My right hon. Friend also raised questions about the rating of eight other NHS acute trusts. In half those cases, no change at all was made to their eventual rating. That demolishes the central thrust of the Opposition attack that officials were somehow under orders to improve the star ratings of those trusts about which my right hon. Friend had expressed concerns. That is patently not the case. Equally untrue is the allegation that changes to the star ratings of individual trusts were made for political reasons. That argument has been comprehensively rebutted by the permanent secretary to the Department of Health—Sir Nigel Crisp made it clear today that he is satisfied that no such improper influences were brought to bear. In not accepting those assurances—indeed, in not even referring to them—Conservative Members are not only impugning the integrity of Ministers, but calling into the question the integrity of civil servants. I find that utterly contemptible.
	The motion also calls for greater transparency in the use of performance indicators in the NHS. That is complete and utter hypocrisy. The Government have gone further than any previous Administration in providing the public with information about NHS performance. We want the public to know what is happening in the NHS and what use is being made of the initial investment. The policy that the Conservative party advocates would return us to the old days when there were no clear national targets for the NHS, and that would be unacceptable.
	It is clear from the way in which the Conservative party has raised the matter that it has only one motive: to deny that any progress is being made in the NHS. That is its sole purpose. In the process of constructing that argument, it wants to help pave the way for its plans to expand the use of private medical insurance. That deeply reactionary and cynical policy would widen health inequalities, deprive the NHS of £2 billion of vital investment and set back its long-term expansion.
	There is no substance to any of the allegations of wrongdoing that Opposition Members have made today. No evidence of impropriety has been disclosed; no misuse of power or authority has been established; no credible or convincing case has been made out that would lend any measure of support to any part of the interpretation of events that the Opposition presented. On that basis, I ask my hon. Friends to reject the puerile and fatuous motion.

Question put, That the original words stand part of the Question:—
	The House divided: Ayes 204, Noes 338.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31(Questions on amendments), and agreed to.
	Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House notes that record investment in the NHS has to be linked to reform, and that this investment and the devolution of power to the front line require greater accountability; congratulates the Government on its record of making the NHS more transparent through the development of performance indicators; welcomes the Government's development of such indicators in consultation with patients and staff; congratulates the Government on giving responsibility for NHS performance monitoring to the independent Commission for Healthcare Audit and Inspection (CHAI), which reports direct to Parliament; and welcomes CHAI's commitment to developing new and more reflective indicators in partnership with representative bodies and the NHS itself.

Care Homes

Mr. Deputy Speaker: I must advise the House that Mr. Speaker has selected the amendment in the name of the Prime Minister. There will be a 10-minute limit on Back-Bench contributions to this debate.

Simon Burns: I beg to move,
	That this House expresses its profound concern at the continuing crisis in care for elderly people; deplores the Government's over-prescriptive, expensive and bureaucratic regulation of the care home sector, which has greatly exacerbated the crisis in care and has led to many care home closures; condemns the loss of over 70,000 long term care places since 1997 and is gravely concerned that the number of people receiving domiciliary care has fallen by 100,000 since 1997; is further concerned that the implementation of the Community Care (Delayed Discharges etc.) Act 2003 will merely place an unfair financial burden on Social Services departments, and could lead to patients being discharged prematurely from hospital into inappropriate care, resulting in an increase in emergency readmissions; and calls on the Government to recognise the crisis in the provision of long term care for elderly people, to take action to reduce the current rate of care home closures and to combat the decline in the availability of domiciliary care, rather than simply disregard the crisis.
	Despite the protestations of Ministers, there is clearly a crisis in long-term care for elderly people. That is not solely my view; it is also the view of many who work in, and provide care in, the long-term care sector. Only last month, the Independent Healthcare Association said the following:
	"As a nation we are facing a crisis".
	The Registered Nursing Homes Association has echoed that view, and the National Pensioners Association has declared that
	"there is clearly a crisis in care and older people are suffering".
	Ironically, the only person who seems oblivious to the crisis is the Minister with responsibility for long-term care, the hon. Member for South Thanet (Dr. Ladyman), who declared the following in an article in "This Caring Business" last November:
	"There is no national crisis in the sector".
	Frankly, the hon. Gentleman must be in denial if he is unaware of the crisis that is so apparent to everyone else. It is time that he began to listen to the concerns of those working tirelessly and selflessly to care for some of the most frail and vulnerable in our society, and to pay attention to those elderly people who are entrusted into such care.

Andrew Mitchell: Far from the Minister being complacent, should he not be losing sleep and worrying greatly about the state of social services in Birmingham? Is my hon. Friend aware of the recent Audit Commission report, which singled out social services there as absolutely appalling and deeply letting down local people? What does he think that the Minister should be doing about that?

Simon Burns: I am extremely grateful to my hon. Friend for that intervention, and I shall indeed refer to Birmingham at a later stage. He will be as aware as I am that in the year to the middle of 2003, 96 homes closed in Birmingham. Social services have been forcing down prices to a level at which it is not feasible to run homes. They are prepared to pay only £265 per client, whereas in respect of their own homes they are prepared to pay £525. I agree with my hon. Friend that it would be more reassuring for the elderly and their families in Birmingham if Ministers—including the Minister and his predecessor—were prepared to spend more time and be more concerned about examining what is causing so much distress in relation to care problems in the city of Birmingham.

Patrick McLoughlin: My hon. Friend has just dealt with problems in Birmingham. Does he acknowledge that one problem that greatly annoys people who run private care homes is that the local authorities pay much more to their own care homes than they are prepared to pay to the private sector? That is one of the big problems often put to me by private care home owners.

Simon Burns: My hon. Friend raises an important and valid point. The fact that that is happening all over the country is not only unfair, but anti-competitive. If my hon. Friend will allow me, I shall deal with that point again later in my speech.
	I believe that the Government can pursue two options: either the dangerous one of remaining in denial and doing nothing, or the positive one of seizing the opportunity to end the current confusion and crisis surrounding the care of some of the most frail and dependent members of our society. Because the Under-Secretary seems so oblivious to them, it might help if I explain the problems facing the care of elderly people in this country.
	The first problem is the collapse in the provision of homes and beds throughout the country. The most recent data published by Laing and Buisson in July shows that long-term care capacity across all sectors is now some 74,000 places lower than its peak in 1996. Indeed, some 13,400 elderly care places were lost in the 15 months to April 2003 alone, yet demand for elderly care is growing. We estimate that between 2005 and 2020, 130,000 more people each year will require care than currently receive it—an increase of 25 per cent.

Meg Munn: What would the hon. Gentleman say to my constituent, Mr. Watson, who is currently waiting to be discharged from hospital? He wants to go home and be cared for by his family, not to go into a nursing care home. Is it not the case that most people want to stay at home and do not want to go into nursing care homes? Is that not the real issue?

Simon Burns: The hon. Lady makes a good point and is, in many ways, quite right. I would say to her constituent that he should not remain in hospital any longer than is clinically necessary, and that he should receive the most appropriate care for his needs. If the hon. Lady will bear with me, I shall discuss the issue in greater detail in a few moments.

David Hinchliffe: I am glad that the hon. Gentleman has clarified that point in response to my hon. Friend the Member for Sheffield, Heeley (Ms Munn). As a Minister responsible for community care in the previous Conservative Government, does he feel that his Government bear any responsibility for the current difficulties in the care sector? In particular, in the 10-year period before community care changed in 1993, there was a 4.7 per cent. increase in the number of elderly people, but the Conservative Government increased care and nursing home places by 500 per cent.? Is that not a factor in our current difficulties?

Simon Burns: No, it is not a factor. As the hon. Gentleman will recall, when community care was introduced with the support of his party in the early 90s, we had to deal with circumstances that needed to be controlled because of excessive—and I choose that word carefully—growth. The growth was due to demand and was not stimulated by Government. I shall return to that point later, as the portion of my speech that concerns domiciliary care was written with the hon. Gentleman in mind. I know his views, which he has made clear in the Health Committee.
	In the 15 months to April 2003, about 13,400 elderly care places were lost, yet demand for elderly care is growing. We estimate that, between 2005 and 2020, more than 130,000 more people each year will require care than currently receive it—an increase of over 25 per cent. New analysis shows that, as a result of that projected growth in demand, and of the rate of decline of availability of care, overall demand for care home places will outstrip supply by 2005—that is, in just 12 or 24 months.
	The human consequences are potentially dire. I know that the Government—and the Minister, who has done it often before—will claim that the problem is not as great as it seems, because there are about 10,000 spare beds in the country. However, what the Minister sadly fails to understand is that that spare capacity is not located where the demand is. Too often, areas where there is a shortage of beds are also those areas where demand for beds is greatest. The unfortunate result is that, too often, elderly people have to be placed further and further away from where they have lived all their lives, and from where their families and friends live. That is deeply distressing to elderly people, and to their families and friends. They feel that they are becoming increasingly isolated, in unfamiliar surroundings.
	However appalling the problem is, we must not forget that residential care is only one element of care for the elderly. It is important to remember that the guiding principle for the provision of long-term care must be that the elderly receive the most appropriate care suitable to their needs. That care may be provided in a residential home but, equally importantly, it could also be domiciliary care provided in the familiarity of an elderly person's own home. Unfortunately, however, the number of people receiving domiciliary care has fallen by almost 100,000 since 1997.

Meg Munn: Will the hon. Gentleman give way?

Simon Burns: No, I want to make some progress. That is a fall of more than 20 per cent., and it came about even though the 1997 royal commission on long-term care emphasised the need for increased levels of domiciliary care to allow people to retain their independence for as long as possible—something about which all hon. Members are, I am sure, united. It is all very well for Ministers to state that the provision of domiciliary care rose between 1997 and 2002, but that is disingenuous spin.

Stephen Ladyman: indicated dissent.

Simon Burns: The Minister may laugh, but Department of Health figures show clearly that, although the number of contact hours being provided has increased by 14 per cent.—as the Minister is very fond of saying—the number of households receiving services has fallen by 23 per cent.

Angela Browning: I am not surprised by the figures that my hon. Friend has quoted. I have done a lot of case work in this area and I know that the system involves people filling in endless tick boxes. The aim seems to be to stop people receiving anything, and not to make available the small amounts of care that would help them to maintain their independence. It is another example of bureaucracy gone mad.

Simon Burns: I fear that my hon. Friend's experience is replicated all too often around the country.

Meg Munn: The hon. Gentleman may be aware that I have worked in this area for some considerable time. I was involved in the process of consolidating domiciliary care for those in need of intensive care. The aim was to give people like the constituent to whom I referred earlier the option to go home. That means that much greater care must be devoted to fewer people.

Simon Burns: I disagree with the last part of the hon. Lady's statement. I fully recognise, as will anyone familiar with domicillary care, that many clients need highly intensive and time-consuming care. The fact is, however, that if, because it is considered more appropriate, we want more people to remain in their own homes rather than going into residential care, we need more domicillary care. Ministers repeat the mantra, "We have increased domicillary care". Yes, their figures show that the number of contact hours has increased, but not the number of people who need the care. That is the nub of the problem.

Joan Humble: Will the hon. Gentleman give way?

Simon Burns: No, I am going to make progress.
	The question is why there has been such a contraction in care capacity. Part of the reason has been the policy of social services departments to use their bulk purchasing power to force down the price that they are prepared to pay for beds, as my hon. Friend the Member for Sutton Coldfield (Mr. Mitchell) said. Nowhere, as I told my hon. Friend, has that been more apparent than in Birmingham, where the price paid in the private sector has been forced down to £260 per resident while the price paid in the local authority homes is £525. That has resulted in 96 care homes closing down in the two years to 2002.
	In addition, the introduction of more and more bureaucratic regulations, many of which were minimal in raising care standards, has contributed to home closures. Before any Minister tries to misinterpret what I am saying, let me make it quite clear that no Conservative Member opposes in any way the raising of standards so that frail and elderly people can have the highest possible care. What we object to is unnecessary and over-prescriptive regulation. While the Secretary of State continues to mutter from his sedentary position, he should recognise what I am saying. His own Government, before he became Secretary of State, did a U-turn on regulations, recognising the problems that there were.

Laura Moffatt: Will the hon. Gentleman give way?

Simon Burns: No, I will not.
	In addition, since 1997 we have experienced the Government's over-prescriptive, centrally driven approach, which I believe has contributed to the current crisis in care. In the last two years, we witnessed the Government's ridiculous and unnecessarily prescriptive implementation of some of the national minimum environmental standards. Then the Government had to do a U-turn. We saw the over-zealous and complicated implementation of Criminal Records Bureau checks for care home staff. Then the Government had to climb down. The Government vigorously imposed regulations but then said that they would use a lighter touch, because even they came to understand that their approach had been too officious.
	What we have not seen is consistency and a level of regulation that is reasonable to ensure that standards are raised to the levels that we all wish to see. Just last week, we saw the implementation of the Community Care (Delayed Discharges etc.) Act 2003, under which it is intended to fine local authority social services on a daily basis for delayed discharge payments. As I highlighted during the Bill's passage, we remain implacably opposed to what I consider to be a nasty and vindictive piece of legislation that will simply exacerbate a difficult situation and unfairly impose fines on local authorities that are unable, often through no fault of their own, to find places in homes or provide domicillary care packages because of the crisis in long-term care brought about by the Government's indifference.

David Heathcoat-Amory: My hon. Friend has not so far mentioned the cost of regulation. Care homes in Somerset are complaining about a 20 per cent. increase in the regulatory cost from the National Care Standards Commission on top of a similar increase from the Criminal Records Bureau, which my hon. Friend mentioned. Will he comment on how the squeeze between low fees and rising regulatory costs simply means that fewer people can be cared for? Perhaps that is the root cause of the problem that he is addressing.

Simon Burns: My right hon. Friend is right. It is, of course, a double whammy in terms of costs. In addition to the significant increase in the costs that care homes have to pay to comply with many standards are the costs of the fees to ensure that they are complying. For example, registrations fees to use the Criminal Records Bureau have increased by 147 per cent. in 18 months, which has a significant impact not only on the larger homes that employ more people, but on small homes, for which it is a disproportionate amount of their costs. As he no doubt finds in Somerset, many of them—especially, although not exclusively, the smaller ones—have thrown in the towel because financially they cannot continue to provide care. They have either sold up or converted the homes into domestic dwellings and left the market. That has contributed to the problems we face.

David Taylor: How does the hon. Gentleman justify the actions of his political colleagues in Leicestershire who took control of the authority for the first time for more than 20 years on general election day? They immediately decided to flog off the remaining 14 residential homes that were operated by the county, which had achieved the highest standards of physical and care provision. Is it not disgraceful that the residents of those homes were not even treated as sentient beings, but just as objects to be moved around?

Simon Burns: I do not share the hon. Gentleman's final analysis. I have no doubt that Leicestershire social services did not treat the clients in their homes as objects.
	On the general principle of whether it was wrong for the homes to be sold, it is up to any social service department and local authority to decide whether to continue to provide in-house care or to sell their homes. One reason why I have not opposed local authorities selling their care homes is that for many years those homes were not under the same inspection regime as the private sector. As they did not invest in their homes, for whatever reason, the quality and the fabric of the buildings—not the quality of care—deteriorated. The money was not available to invest in the homes to make them comply with the Government's minimum standards. It would have benefited the people living in those homes if the person who ran and owned them had the money to invest to improve and enhance the buildings and to maintain the highest standards of quality of care.

Joan Humble: Will the hon. Gentleman give way?

Simon Burns: No.
	The Community Care (Delayed Discharges etc.) Act 2003, which came into force on 1 January and into effect this Monday, is illogical and unworkable. It will do nothing to combat the problem of delayed discharges in our hospitals. Indeed, it has the potential to make the situation dramatically worse. Attempting to resolve the problem of delayed discharge in that manner is bizarre. Fining local authorities will place new burdens on them—

Hilton Dawson: Will the hon. Gentleman give way?

Simon Burns: No, I will not.
	The fines will lead to an increase in red tape, damage relationships between local authorities and the NHS, and increase the likelihood of inappropriate discharge decisions. The 2003 Act is a knee-jerk reaction to the serious problem of delayed discharges and is incredibly short-sighted, endeavouring to reduce the levels of delayed discharges by imposing perverse incentives in the form of fines rather than positive long-term solutions.

Hilton Dawson: rose—

Kali Mountford: rose—

Simon Burns: I have been extremely generous in giving way and I want to make progress.
	The Government have missed a golden opportunity. If they were to legislate, they should have come up with a positive system of reducing the number of delayed discharges in our hospitals rather than the negative approach of introducing a fines system. These measures will also undo the excellent work that has been established over the last 15 years in fostering good working relationships and partnerships between the NHS and social services departments. That work was long overdue and it has led to a more seamless provision of service. It will—[Interruption.] The Secretary of State says that we were in power, but if he had been listening carefully he would know that I said "over the last 15 years". If he looks through his history books, he will notice that a Conservative Government as well as a Labour Government were involved in that work.

John Reid: That is precisely the point that I was making. The hon. Gentleman talks of the lack of money provided by Governments over the last decade—[Interruption.] He mentioned money about four minutes ago. Earlier, he also mentioned the lack of Government support during the past 15 years, so will he at least accept that a significant proportion of the alleged deficiencies must have come from the Government whom he supported? Indeed, as far as I can recall he was a member of that Government for a prolonged period.

Simon Burns: I do not think that the Secretary of State was listening carefully so I shall repeat what I said so that he can fully understand me—[Interruption.] The right hon. Gentleman obviously did not hear me because his intervention bore no relation to what I said. I said that the measures would undo the excellent work that has been established over the last 15 years in fostering good working relationships and partnerships between the NHS and social services departments. I still believe that. Tremendous work was done in the 1990s and also, to be fair, under the Labour Government who have taken it to a logical conclusion, to ensure that the barriers—the them-and-us culture—between the NHS and social services were broken down and that the organisations worked seamlessly to provide a better service.
	I applaud the Government for doing that, just as I applaud the last Conservative Government for laying the foundations and starting the work. It is a good step forward and it must be continued. My concern, however, is that the Act that came into force last week will set back that good work, because it could reintroduce a blame culture when decisions are taken about when and how to discharge patients.
	Another consequence of the enforcement of the Act is that the number of emergency readmissions will rise further as patients are discharged prematurely from hospital so that local authorities can avoid hefty fines for delayed discharges. There will be a costly, time-consuming, bureaucratic shambles, which could result in the opposite of what the Government intended.

Stephen Ladyman: How could that possibly be the case when the delayed discharge reimbursement system will not apply until a clinician has said that the patient is ready for discharge?

Simon Burns: The clinician may say that, but it may not be physically possible for the local authority to find a place for the patient in a home or to provide a domiciliary care package. We shall see arguments between the NHS and social services about whether a patient should be discharged, although I accept that the whip hand in the decision-making process rests with the NHS.
	Have Ministers considered how the burden of the fines could affect their constituencies? Of course, the Secretary of State must be delighted. This health policy, like all the Government's other health policies for England, will not impact on his constituency one iota. He is in a unique position in the ministerial team in that he is the only member of it whose local social services department will not face the possibility of paying out tens of thousands of pounds in delayed discharge fines every month, as his constituency is in Scotland and thus immune from this rather nasty measure.
	How will the measure affect other health Ministers? Let us consider the social services department in the county of the Under-Secretary of State for Health, the hon. Member for South Thanet. My hon. Friends may not remember that Kent is implacably opposed to the Minister's policy. Anyway, it originally estimated the cost of fines as potentially some £5.2 million a year.

Julian Brazier: Will my hon. Friend give way?

Simon Burns: I would like to make a little progress.
	As the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton) will undoubtedly know, her local social services department will receive £315,000 for the remainder of the current financial year and £600,000 for next year. Although the department hopes that that will be enough to cope with the fines, it is not yet sure how much it will have left to invest in mechanisms to reduce the number of delayed discharges in the future.
	In any event, this is a case of robbing Peter to pay Paul. Rather than being spent actively and positively in toto on mechanisms to reduce the number of delayed discharges, central Government money is being given to social services departments with one hand and taken away with the other, in fines. That is a cockeyed system. The net result is that the money, often a significant amount, is not being used constructively.
	The Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson)—who, unfortunately, is not present—will find that her local social services department expects fines in the region of £25,000 a week. We have to ask whether that considerable sum could not be spent more positively and productively. As for the department in the constituency of the other Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), it originally estimated that its fines would cost about £2.74 million in the first year of implementation. Again, exorbitant amounts are being used in fines rather than being spent positively and meaningfully to tackle a problem.
	I believe it is time the Government acknowledged the urgent need to give more security and confidence both to our vulnerable elderly people and to those who care for them. That is why I urge my right hon. and hon. Friends to support the motion.

Stephen Ladyman: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the real terms increase in social services funding of 20 per cent. between 1997 and 2003, and the commitment to continue these increases by an annual 6 per cent. in real terms from this financial year to 2005–06; notes that councils are able to use these resources to increase fees they pay to care homes where they think necessary, with 2002–03 figures showing 56 per cent. of local councils in England and Wales increasing the fees they pay by at least 5 per cent; notes that the Laing & Buisson Care of Elderly People Market Survey published in July 2003 puts bed capacity in care homes from all sectors at 470,000 with demand estimated to be around 460,000; further notes that over 80 per cent. of older people say they want to live independently in their own homes for as long as possible; supports the Government's policy of improving choice by providing alternatives to residential care with 20,900 more households since 1998 receiving intensive home care packages, 143,200 additional people receiving intermediate care services since 1999, and a cash injection of £87 million to be spent on creating 1,500 new extra care housing places by 2006; and further supports the Government's policy of driving up care standards where the care is delivered and ensuring that older people are not held unnecessarily in acute hospital beds when their care needs can be better met elsewhere.'."
	Fond as I am becoming of these exchanges with the hon. Member for West Chelmsford (Mr. Burns) and the jousts in which we are increasingly engaging, on this occasion I can offer him no comfort—there seems to be no common ground between us. The voice of the care industry speaks loudly to him and his party, but the voice of older people speaks more loudly to the Government. The Conservatives seem determined to champion the providers of care; my hon. Friends and I know of the importance of the people who provide care, but we put the needs of those who use it first.

Chris Grayling: Will the Minister give way?

Stephen Ladyman: I will establish my thesis first.
	The Conservatives seem wedded to a model of care for older people that could have been plucked from the 1980s. To them it seems that dependency and a care home place are the inevitable result of old age. We take a different approach. We want to put the individual at the centre of care. We want to offer a spectrum of care choices, and we will go the extra mile to help people maintain their independence and stay in their own homes for as long as possible.
	Our vision is a million miles from the service that we inherited in 1997. Although we are much closer to it today than we were then, we are not there yet. We inherited a low-quality, dependency-based care system that was imposed on people because it was all that was on offer to them. In its place, we are building a high-quality, well-regulated system that makes independence a real option and gives individuals control of their care.
	As we make that transition, however, the care industry and the market in which it operates will have to adapt. It will be a challenge for the industry and for care users, but it is not a challenge that we can duck. It saddens me, therefore, that rather than helping the industry to adapt the Conservatives have decided to set their face against change and to swallow every myth that the care home sector wants to throw out.

Chris Grayling: Will the hon. Gentleman give way?

Stephen Ladyman: No. Let me establish my thesis, and then I will certainly give way.
	Let us start with some of those myths: first, the notion that older people want to end up in care homes. They do not. More than 80 per cent. of them tell us that they want to remain independent and to live at home for as long as possible. The second myth is the so-called care home crisis. Yes, the number of care home places is falling year on year, but when will the Opposition understand that demand for those places is falling at an even faster rate?

Simon Burns: The Minister says that 80 per cent. of old people want to remain in their homes, so 20 per cent. presumably do not want to do so. Given that only 4.6 per cent. of people between the ages of 75 and 84 live in residential homes, what happens to the other 15.4 per cent.?

Stephen Ladyman: If the hon. Gentleman is seriously telling me that he believes that older people want to end up in care homes and do not want to maintain their independence for as long as possible, he is, frankly, barking mad.

Chris Grayling: Will the hon. Gentleman give way?

Stephen Ladyman: I will give way to the hon. Gentleman in a moment.
	I do not dispute that the number of care home places is falling, but by no stretch of the imagination is that a crisis; it is an inevitable contraction of market capacity, following a reduction in demand. People simply do not want to be in care homes any longer, and the Government are giving them a real opportunity to stay in their own homes instead.

Chris Grayling: rose—

Stephen Ladyman: As the hon. Gentleman is being persistent, I will let him make his point.

Chris Grayling: I thank the Minister for giving way, but he is absolutely out of touch with the realities in care homes. Does he not recognise that there are very many people suffering from the chronic conditions of old age—Parkinson's and Alzheimer's—for whom a place in a care home is not just an option, but a necessity? Many of those people are stuck in hospital beds, unable to get the care that they need. What the Minister describes is absolute poppycock. Those people need places; they need help and support; and the Government are letting them down.

Stephen Ladyman: The hon. Gentleman should not ask questions that he does not want to know the answer to. My mother has severe Parkinson's, and I can tell the House that she will do everything in her power to stay out of a care home. I believe that everyone else—the people that the Parkinson's Disease Society and the Alzheimer's Society represent—are all in the same position. Of course I accept that, eventually, some people will have to go into care homes, and the care home sector will remain an important part of the spectrum of choice that we want to offer.

Several hon. Members: rose—

Stephen Ladyman: I will make a little progress before giving way to all those hon. Members who want to intervene.
	We want to offer real choice. The Government no longer collect care home figures, so the best figures that we currently have available are those collected by Laing and Buisson—a respected and independent health care consultancy. As the hon. Member for West Chelmsford said, it says that 470,000 places are available in the United Kingdom today and that there is demand for just 460,000 of them. Of course, I acknowledge that there are more difficulties in some parts of the country than in others. Those local problems need to be addressed locally, but even the Tories ought to accept that that is in no way a national crisis. In a minute, I shall describe some of the ways that we are giving resources to local people to deal with local issues.

Several hon. Members: rose—

Stephen Ladyman: I shall give way to one hon. Member and then I will make some progress.

Bob Spink: I thank the hon. Gentleman for giving way. Does he accept that the very report that he has just cited states that demand for care home places is expected to expand again from 2005 because of population ageing?

Stephen Ladyman: If the hon. Gentleman will bear with me, I will give some alternative views from other respected consultancies on that very figure, but I accept that Laing and Buisson believes that a further expansion in demand might take place. However, I remind the hon. Gentleman that the same report said that occupancy levels in care homes have only reached 91.3 per cent. and pointed out that that is still a relatively healthy proportion of capacity that is full.
	If there is a crisis in the sector, why did Richard Nunn, director of surveyors, valuers and agents at Christie and Co., write in Caring Times last November:
	"We have noted the activity of private equity companies keen to find rising markets in which to invest their capital. Their burgeoning confidence in the care home sector emphasises the opportunities available to the astute investor. We are also encouraged by the number of existing operators who are looking to extend their portfolios"?
	Mr. Nunn is not the only person to say that. Another article says:
	"The improvement in profits for the six months ended March 2003 reflects both better occupancy levels at the company's homes and improved margins".
	Its author describes the improved margins as being
	"in line with the rest of the industry".
	Later in the article the author says:
	"The financial position continues to strengthen and the company is well placed to take advantage of opportunities for expansion. These continue to be sought".
	Those are the words of the chairman of Univent plc, which is a nursing home and domiciliary care company. The chairman of the company is none other than the hon. Member for South Suffolk (Mr. Yeo), the shadow Secretary of State for Health.

Several hon. Members: rose—

Stephen Ladyman: I shall give way to the hon. Member for Canterbury (Mr. Brazier), who is my neighbour.

Julian Brazier: The Minister told us that his main concern was with the elderly recipients of care rather than the industry. As a fellow Kentish Member, does he really think that it is fair that when bidding for places in Kent's overcrowded care homes sector, people from London receive funding rates that are more than twice the rates that Kent county council can afford for our elderly, especially given that he knows that our social services in Kent are overburdened in other ways, not least in the children's sector due to unaccompanied asylum seekers?

Stephen Ladyman: The hon. Gentleman and I clearly have different conversations with officers from Kent county council. They tell me that there is huge capacity in the care home market in Kent. Yes, they constantly tell me that they think that it is unfair that London councils receive more funding and can therefore afford to pay better prices in the north of the county, but I do not believe that there is anyone from London with a care home place in the hon. Gentleman's constituency—certainly very few people are placed in care homes in my constituency by London authorities. The situation about which he talks is simply not a factor.
	In this House, the hon. Member for South Suffolk is keen to promote the idea of a care home crisis, but when he writes for the stock market and his investors, he is keen to promote the idea of a booming sector in which money can be made. The truth is that the number of care home places reached a peak in 1995–96, as the hon. Member for West Chelmsford said, and began to contract as the National Health Service and Community Care Act 1990 started to bite. The number of places has been falling continuously since, but demand is falling faster still. Supply and demand are now starting to come into balance in many areas, which is why the hon. Member for South Suffolk and other industry spokesmen see a strong future for providers. Laing and Buisson, for example, believes that the rate of closures has slowed down significantly over the past two years, but I do not believe that we are at the end of the process yet.

Tim Boswell: rose—

Stephen Ladyman: Let me make this point because it relates to an earlier intervention.
	The personal social services research unit at London school of economics recently observed that if dependency rates fell by 1 per cent. per year, which is by no means unlikely, the number of older people cared for in care homes could remain roughly constant between 2000 and 2020 despite the rising numbers of older people. If that is combined with increasing choices and changing patterns of care, I believe that it is likely that the number of people requiring care home places could fall even further.

Tim Boswell: When I asked the Prime Minister whether he was the only person in the country who could see no connection between the 25 per cent. decline in care home places offered in the south of my county and the ratio of delayed discharges, which was reported at column 299 Hansard on 20 March 2002, he said that there was, of course, a connection and took some credit for the fact that the Government were providing additional resources to create or free up more beds. If even the Prime Minister could see that point, does the Minister accept it?

Stephen Ladyman: That is why we have made a building capacity grant to local councils and have put substantial sums into the reimbursement scheme in the Community Care (Delayed Discharges Etc) Act 2003. We want to enable councils to make preparations for the requirements of that measure, and I shall deal with that in more detail later.

Paul Burstow: The Minister has just cited research by the personal social services research unit, which found that a 1 per cent. reduction in dependency rates would stabilise the number of people going into care homes. Does he nevertheless accept that people receiving care at home are becoming increasingly dependent and are receiving more hours of care? Consequently, fewer people are receiving care at home, so the aim of reducing dependency is hampered by the fact that the Government are not providing sufficient support for home care for people with lower-level needs.

Stephen Ladyman: I thought that the hon. Gentleman was about to make a sensible intervention, but at the end of his question he lost the plot. We are increasing the number of hours available for home care and are targeting them on more intensive packages that enable people to remain at home. We are giving huge amounts of extra resources to local councils so that they can continue to build capacity for intensive home care. However, I agree with the hon. Gentleman's sensible suggestion that, as there is an increase in the elderly population and life expectancy, and as we want to keep people out of care homes—the LSE figures suggest that we might be able to do so—we must maintain many more people at home through intensive care packages. It is the Government's policy to provide resources to achieve that.

Mark Todd: My hon. Friend is making a coherent case, but he has not touched on the fact that when we talk about market forces and the effect of home closures, we must recognise that the residents of those homes are clearly involved in the delivery of that market force effect. We should consider using a methodology to regulate that effect better. My hon. Friend commended research by Laing and Buisson, which has suggested a methodology for negotiating a proper rate for home care. Has he considered whether it is appropriate?

Stephen Ladyman: I congratulate my hon. Friend on his constructive approach—I only wish that Opposition Members were equally constructive. I am considering the possibility of developing a model to allow the fair negotiation of price, and I shall discuss that later. The hon. Member for Isle of Wight (Mr. Turner) is not in the Chamber today, but there was recently a strike by care home operators on the Isle of Wight because they did not like the price that the local council was offering them. That price was calculated using the Laing and Buisson model, so it does not always meet people's needs. We must take that issue into account.
	Loss of care home capacity in areas where there is a significant over-supply is not a problem, provided that closures are managed sensitively. There is a greater problem when losses occur in an unplanned way in areas where there are few other alternatives or where supply and demand have not yet reached a balance. When that happens, it is important that action is taken by local authorities to rebalance provision. That might mean increasing fees, either to attract homes to expand or to encourage new homes to open. It might mean working with social landlords to create new care choices, or it might mean the local authority stepping into the market and providing council-owned homes. Those are all valid options for local decision, and cannot possibly be controlled successfully from the centre, which is why I have resisted calls for a national review of care home fees or demands that I try to impose particular solutions from Whitehall.

Chris Mole: rose—

Chris Grayling: rose—

Stephen Ladyman: If my hon. Friend the Member for Ipswich (Mr. Mole) and the hon. Member for Epsom and Ewell (Chris Grayling) will forgive me, I want to make some progress, but I shall give way later.
	To tackle the problem, we have given local authorities substantial extra funding, together with the responsibility to manage care home capacity in their own areas. We have given resources dramatically above the level of inflation since 1997. We gave local authorities 20 per cent. more funding in real terms for personal social services between 1997 and 2003. We gave them a 6.3 per cent. real-terms increase on top of that this year, and we have promised them a 6 per cent. real-terms increase next year and the year after, as well. Compare that with a 0.1 per cent. annual increase between 1992 and 1997.
	This year councils have just over £13 billion to spend on personal social services; by 2005–06 they will have around £15 billion. That will be close to double the amount available when this Government came to power. Before anyone argues with these figures, the percentages I have used have been calculated on a like-for-like basis and adjusted to take account of additional responsibilities.

Andrew Mitchell: I do not dispute what the Minister says about the additional resources that have been made available. Can he explain why the Birmingham social services department, of which I hope he is well aware, remains in such a shambles?

Stephen Ladyman: Birmingham social services has serious challenges to meet; there is no question about that. One of the things that that department has decided to do, as the hon. Gentleman says, is to maintain its own care homes, because it believes that that is necessary to rebalance provision in its area. It has taken exactly the sort of decision that we are encouraging councils everywhere to take—to look at their local area and ask themselves, "What do we need to do locally to make sure we provide for our older people?" I realise that the hon. Gentleman has a problem because the social services department pays more to those homes than to the private sector. My advice to him—I think I have given him the advice before, but if not, I give it to him now—is that the department can do that only if it has carried out a best-value review and can justify the extra cost on the basis of increased services or quality. He and his constituents just need to get hold of that best-value review and they can find out why Birmingham chooses to pay a differential in rates between the two types of care home.
	The money that we have given to councils is money that they can use in any way they want. As I said, they can increase fees locally, if that is what they need to do; they can invest in new capacity locally, if that is what they want to do; they can make their eligibility criteria for social care more generous, if that is what they want to do; and they can cut the charges that they seek to impose on people who have to contribute to the cost of care at home, if that is what they want to do.
	Some councils have reacted to local challenges with increased fees. Fees paid by councils to independent care operators have increased by an estimated 8 per cent. on 2002–03 figures, well ahead of wages. If anyone is in any remaining doubt of that, again I refer them to the annual reports of the chairman of Univent plc and his boast of increased margins. The key, of course, is to establish a fair market process. Falling demand has created a buyers market, and we expect care home owners to take on board what the market throws at them. But they are entitled to ask that councils also respect the market and do their share to create a level playing field on which businesses can compete to provide services. It is not acceptable for councils to decide how much they want to pay and to tell home owners to take it or leave it, knowing that most home owners will be unwilling to evict council-supported residents.
	Services must be commissioned fairly, using a process that allows the market to establish a fair price for the job and allows individual providers to bid the price they believe appropriate to their business. Once that is done, the council is entitled to take the best price on offer, but it must allow reasonable annual uplifts reflecting genuine annual cost increases. This type of best practice is fair to providers, fair to council tax payers and, most important, fair to service users, but too few councils follow such best practice.
	That is why I have announced a national series of conferences to disseminate best practice commissioning. They start this month, and there is no excuse for any council not to send a representative to those conferences. I will speak at the first one, and my speech will be recorded for the regional conferences to ensure that everyone understands that the Government expect councils to use fair commissioning practice. The Government have done their part by making resources available, and will continue to do so, but local democratic accountability is important too. While the Tories continue to believe in imposing solutions from the centre, and the Liberal Democrats pay lip service to localism, we believe in local solutions for local problems, and we have given councils the power and resources to address them.

Chris Mole: On local choice, does my hon. Friend agree that it is regrettable that the motion does not refer to the option of delivering in partnership with registered social landlords the sort of sheltered housing schemes that deliver extra care, offer people choice, meet modern standards and provide continuity of care as older people's needs change? Such schemes also give older people their own front door and the level of dignity in later years in which we, as a party of choice, believe. The only thing I ask him to do is continue his dialogue with the Office of the Deputy Prime Minister about the availability of local authority social housing grant funds to local authorities to enable more such schemes to be brought on stream.

Mr. Deputy Speaker: Order. Interventions are getting longer, which is taking away valuable time from Back Benchers who wish to contribute to the debate later.

Stephen Ladyman: My hon. Friend is absolutely right—extra care is a model of older people's care for the future that we must promote. We must do so in all sectors, including the private and social sectors. We must do a lot more in that regard, and I shall say a few words about that later.
	The motion's reference to regulation is another example of the Opposition speaking for providers and not older people. When I speak to pensioner groups around the country, they tell me that they want more regulation, not less. They tell me that regulation and inspection should be thorough and rigorously enforced. Did any Member of this House not receive a letter from someone in his or her constituency following the recent "Panorama" programme on care workers, which made that very point? When the Tories were in power, regulation and inspection were at best inconsistent and were non-existent in many places. Every council carried out its own inspections and used its own criteria and decided how hard to push them. The results were poor standards in many areas, bad practice in many homes and abuse and misery for many older people. So we introduced national minimum standards and a consistent national inspection regime. That was the right decision, and it is driving up standards to the discomfort of those who cannot meet them.

Joan Humble: I thank my hon. Friend for giving way. I congratulate him on highlighting the fact that the bulk of the care standards introduced in the Care Standards Act 2000 apply to good social care practice, which providers welcome. Is he aware that providers also welcome the additional investment that he and his colleagues have given through Topss England for training their staff? They want to deliver the best quality of care and they will do that by having well-trained staff. Government investment is helping them with that.

Stephen Ladyman: My hon. Friend is absolutely right. We introduced the national minimum standards and have consulted about them continuously since. As the hon. Member for West Chelmsford acknowledged in an underhand way, we have shown that we are prepared to listen to what is said in those consultations and change the standards where necessary. My hon. Friend is right that we have put huge investment into training people involved in social care and into attracting people into the social care work force.
	Caring for older people is not only about long-term care, however, but about wider choices. That is why we have invested so much in intermediate care—a type of care provision that many developed nations do not even provide, but which we see as a valuable new tool to ensure that older people get the right care at the right time in the right environment and that there is a real alternative to an acute hospital bed. Compared with 1999–2000, by June last year there were approximately 3,600 additional intermediate care beds and about 12,800 additional non-residential intermediate care places. In 2002–03, that meant that 143,200 additional people received intermediate care services compared with 1999–2002. That is a fantastic achievement, which meant that a significant number of people avoided entering an acute hospital, that even more were able to get out of an acute hospital more quickly and that many avoided entering a care home unnecessarily. Would it not be nice if the Conservatives occasionally congratulated us on the success of that initiative?
	Over the past two years, we have made good progress in tackling the problem of delayed discharges. Older people do not want to be stuck in a hospital bed when they are ready to leave, becoming more dependent and less motivated. We have positively managed a reduction of almost 50 per cent. in the number of people over 75 experiencing a delay since 2001, and that progress is continuing as a result of people preparing for the Community Care (Delayed Discharges etc.) Act 2003. By September last year, there were only 2,988 people aged over 75 whose discharge was held up—a reduction of considerably more than half—and informal feedback from October to January suggests, contrary to the claims of the hon. Member for West Chelmsford, that delayed discharges are continuing to fall without any adverse impact on quality whatsoever.
	Councils have been given £50m for the period since last October, and £100m for the financial year to come, to pay reimbursement charges. I invite the hon. Member for West Chelmsford to do some simple arithmetic, although I know that he was not in school when the numeracy hour was introduced. If he multiplies the number of delayed discharges in September last year by the number of days in the year by £100 for each day, it is clear that even if councils did nothing to make the system better, they have been given a sufficiently large reimbursement to ensure that they are no worse off. In fact, if they put a bit of effort into helping with delayed discharges, they would make a profit under the 2003 Act—that is the positive incentive for which the hon. Member for West Chelmsford was calling. I was disappointed by the sloppy thinking in the article in the British Medical Journal that appeared over the new year. Its authors seemed not to realise that we have already consulted on changes to the direction of choice regulations or that we have put in place a single assessment process that means that prior to people's discharge we will have better information about them than ever before. I believe that the 2003 Act will prove to be one of the great successes of this Government, and I look forward to debating it with the hon. Member for West Chelmsford in a year's time when it has finally and incontrovertibly proved itself.
	Our vision is about meeting the genuine hopes and aspirations of older people—for most, that means care in their own homes. To deliver on our vision requires a range of high quality support services and good partnership between all partners. For example, a simple housing adaptation installed in good time can sometimes help someone to stay at home. That is why we have made housing adaptations that cost less than £1,000 free. Home care, especially intensive home care, has an increasingly central role in our plans. The hon. Member for Sutton and Cheam (Mr. Burstow) mentioned that, but he did not say that 81,500 people now receive intensive home care as a result of what the Government have done. Since 1998, we have increased the proportion of people receiving intensive home care by almost 30 per cent. The total amount of hours of home care that we are delivering is 16 per cent. up on the amount that was delivered under the previous Government. We are targeting home care on where it can do most good in keeping people in their own homes, because that is what they want.
	We are targeting our resources at everyone, not at free personal care for the elderly—which the Liberal Democrats mention in their amendment, which was not selected. Those resources became available only because of the tough choice that the Government made in putting £1 billion towards making those choices available for everybody, not giving it to the better off. One of the things that we have been able to do with that money is to make £87 million available from the Department of Health to improve the amount of extra care facilities, which act as seed corn in starting people thinking about how they can increase extra care provision.
	It is a tragedy that too many Conservative and Liberal Democrat spokesmen do not appreciate the importance of the extra care model of housing. I wish that they would go around the country to see some of the people with severe conditions—dementia, Parkinson's or physical conditions—who will be able to stay in their own home because of the extra care model that we are going to roll out. Those are choices that we are making available. It is sad that the Conservatives do not understand that older people want to make those choices and do not see a care home as an inevitable consequence of old age. It is sad that the Liberal Democrats stick with the nonsense of free personal care for the better off when the resources that such a policy would consume would be better spent on making choices available to everybody. If older people cannot hope that the Conservatives and the Liberal Democrats will hear their voices, they can at least be confident that the Government are listening to them and know that they want independence. They want to be respected, given the choice of planning their care, and being at the centre of it. They want dignity in old age, and high quality and well-regulated services. The Government are proud to be delivering that to older people everywhere.

Sandra Gidley: The debate is important and Liberal Democrat Members welcome it. Such is its importance that I was disappointed that the shadow Secretary of State for Health apparently did not feel able to put his name to the motion. However, the previous speech more than covered that issue. I wish to consider a more interesting subject: long-term care for the elderly. It is fair to say that neither of the two larger parties has much about which to be proud, but this is no time to comment on the Tory record, because the Government have also provided a lot of material.

Nigel Jones: I believe that it is in fact time to comment on the Conservative party's record in power. I come from Gloucestershire, where the county council was capped year after year in the early 1990s so that it could not provide the sort of services that we are considering for elderly people. Who was in charge of that damage and distress? The answer is the right hon. and learned Member for Folkestone and Hythe (Mr. Howard).

Sandra Gidley: I dare say there are countless other examples, but today's debate is not about that. [Interruption.] The Tories say, "Let's not bother." That is because they know that the record does not stand up to scrutiny.
	Despite the words of the Government's amendment, they are in no position to rest on their laurels. Before the 1997 election, they promised to set up a royal commission to consider long-term care for the elderly. To give them their due, in December 1997, soon after the election, the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson) said:
	"As people approach old age, many become anxious about how they will be looked after, how much it will cost and who will pay. At the general election, we promised that we would establish a royal commission to work out a fair system of funding long-term care for the elderly."
	He announced the commission and proudly trumpeted:
	"The new Government are keeping yet another of their election promises."
	He described the terms of reference and said that the commission had 12 months in which to report. He continued:
	"The task of this royal commission is neither simple nor easy, but it is important. The present situation cannot go on much longer. People are entitled to security and dignity in their old age"—
	I seem to have heard those words in the past few minutes—
	"so we must find a way in which to fund long-term care which is fair and affordable both for the individual and for the taxpayer. With the independent advice of the royal commission, I hope that we shall be able to establish a consensus from which we can fashion a sustainable system of long-term care that will meet the needs of elderly people well into the new century."—[Official Report, 4 December 1997; Vol. 302, c. 489–90.]
	At the time, the Conservative's big idea was to fund long-term care through an insurance scheme. The royal commission readily dismissed it. However, the Government, having established the royal commission with their usual fanfare, decided to ignore one of its key findings, which was:
	"Personal Care should be available after an assessment, according to need and paid for out of general taxation."
	The Government's response to that recommendation was to declare that they were making unprecedented new investment in older people's services, which would more than fund the cost of the royal commission's proposals. However, they subsequently stated:
	"The Government does not believe that making personal care universally free was the best use of these resources."
	In some ways, I can accept that, but I have heard some worrying rhetoric today. For example, it has been asked, "Shouldn't the rich pay?" The fact is that it is not the rich but people on modest savings who pay. They still have to sell their houses and break into their savings to provide funding in a way that they never expected to have to do. I believe that the Government would admit that that is unfair to many people.

Stephen Ladyman: Seven out of 10 people already get some help with the cost of their personal care. Those who still live in their home do not have to have the value of it taken into account when their contribution to personal care is being assessed. The hon. Lady is talking about making personal care free to the better-off. If we had another £1 billion or so, which would be necessary to do that, could she honestly say that it would be better to give the money to people who already have resources than to spend it on enabling more and more people to stay in their homes for longer?

Sandra Gidley: The Minister is merely reinforcing the inverse snobbery that is so prevalent in the Government. Seven out of 10 people may receive some help, but the other three out of 10 are not necessarily wealthy. We shall shortly have the same debate on tuition fees.
	What is the point of setting up a royal commission if its advice is to be so roundly ignored? The Government will probably claim that they accepted the bulk of its recommendations, and that it would be wrong to place too much emphasis on this particular one. It might therefore be useful to turn to the statement made by the royal commission on long-term care, which was published in September 2003 and whose purpose was to review the extent to which the long-standing problems in long-term care and its funding had been resolved since the commission reported. The statement points out that the debate about long-term care and its funding is very much alive, that little has been resolved, that Governments in most of the UK still decline to act, and that there is widespread concern. That is the view of the commissioners. The statement also reminds us that this is an important issue not only for older people and their families but for the wider public.
	The statement was damning, and highlighted other areas in which the Government's response had been disappointing. The first related to the setting up of a national care commission. The Government will point out that they have set up the National Care Standards Commission, but the remit of that body is much narrower than that envisaged by the royal commission, as its role is merely regulatory and falls far short of the wide-ranging role proposed by the royal commission. The reality is that the establishment of the new Commission for Social Care Inspection will result in a further erosion of the principles originally envisaged by the royal commission.

Meg Munn: My vision is that increasing numbers of elderly people will not need to go into long-term residential care and that they will be able to stay at home, sometimes at a greater cost than would be incurred by their going into a nursing home. How will anything that the hon. Lady is describing help to achieve that goal?

Sandra Gidley: I cannot argue with the hon. Lady's long-term vision, but if she will wait for me to develop my argument, she will see that, while her vision is worthy, it is not being fulfilled by the Government or the party that she supports.

Chris Grayling: The hon. Lady has talked extensively about the recommendations of the royal commission. Has she made an estimate of the proportion of a typical nursing home fee of £500 a week that is taken up by personal care, and that she is arguing should be funded? What proportion of such a typical fee does she believe should be paid for?

Sandra Gidley: I am sorry that I do not have detailed figures; I only have the overall costs. I do not know if the hon. Gentleman is referring to our manifesto pledge, but I can assure him that it is fully costed.
	The bulk of the report consisted of condemnation of the Government's refusal to adopt free personal care for the elderly. Tempting as it is to concentrate on that aspect of policy, however, it is not the only issue in this very crowded field, and I want to spend a little time examining the Government's record. It is difficult to argue with the assertion that people would prefer to stay at home. Many people would agree with that, but is it actually happening? Is that what the Government are achieving?
	It is difficult to get to the bottom of this issue. The latest figures show that, in 2001–02, some 1.4 million people were helped to live independently at home through the provision of a variety of community-based social services. This was an improvement on the 2000–01 figure. A response to a parliamentary question revealed that no figures were available for the years prior to 2000–01. Strangely, however, I came across some figures provided to the Health Committee in the public expenditure memorandum of 2001, which showed that an estimated 1.5 million service users were then receiving community-based care. The reality is, therefore, that 100,000 fewer people are now receiving such care. As the hon. Member for West Chelmsford (Mr. Burns) pointed out, that seems completely contrary to what the Government are trying to suggest.
	Although more money is being provided, it is reaching a smaller number of people. I have noted the carefully worded ministerial replies that refer to intensive home care packages. Those have increased, but a definition of "intensive" has been difficult to obtain. The reality is that the number of households generally receiving any sort of care has been reduced. I cannot square that with helping more people to stay at home. Many cases can be cited from around the country in which an older person who lives at home needs a small adaptation but cannot get it until they fall over, end up in hospital and social services come to the rescue. It seems that the system is skewed and is reactive rather than proactive.
	The Minister said earlier that people can have home improvements, but in many cases those will take six months to happen, and those six months can be six months of misery. A constituent of mine told me about her husband whose situation meant that they had to have a downstairs toilet. In the interim before it was built, the only way in which they could cope was to have a commode in the main downstairs room. This lady felt that she could not invite any friends home. Is the Minister happy to preside over a situation in which people must wait months to receive the help and care that can help them get on with their lives? I think not. He will surely admit, however, that his priorities are skewed.
	We should move on from the question mark over the figures, because that is a relatively small matter. What is of paramount importance is whether people who receive domiciliary care packages are receiving the service that they require and that they deserve. A report called "Nothing Personal" by Help the Aged, highlighted certain worrying findings. It found that levels of care often fell short of the hopes and expectations of those interviewed, and staffing pressures meant that the number of care hours that could be provided often met only the bare minimum of needs and sometimes did not adequately cover that. There was a particular problem with low-level users, unreliability and poor time-keeping of care staff left users in substandard living conditions and sometimes even in danger, and a common complaint was that management allowed workers insufficient time to travel between appointments so that they often arrived 10 to 20 minutes later than expected. That problem was exacerbated when users did not receive a single carer regularly, especially if the user's residence was remote or difficult to find. The report also found that the quality of care varied significantly within authorities, some agency workers simply could not cope with the tasks that they were asked to perform, care was particularly unpredictable at bank holidays, and all too often users were let down, especially by agency staff. Some Members will have watched the chilling "Panorama" programme that covered the same subject area. Evidence from Age Concern seems to indicate that that programme did not have to try hard to obtain material and that, sadly, the situations portrayed are commonplace.
	I do not want a glib response from the Government saying that the matter is in hand and that all will be well because the National Care Standards Commission now has responsibility for this important area. In theory that is right, because the commission theoretically took over responsibility in April last year. All domiciliary care agencies operating before 1 April last year should have registered by 31 March, and any agencies wanting to set up after that date had to be legally registered before they could begin providing care—[Interruption.] I do not know what the hon. Member for South Dorset (Jim Knight) finds so amusing, but perhaps his constituents can enlighten him as to the reality of some of what I am talking about—[Interruption.] I apologise if he was actually coughing, but I am not sure about that.
	The Government made arrangements so that existing domiciliary care agencies can continue operating until their application is determined—granted or refused—and no inspections would take place in the first year. At first glance, that is all very sensible. I draw the House's attention, however, to the reply to a parliamentary question that was tabled on 1 December last year but only answered on 5 January. It asked how many domiciliary care providers have, first, applied for, and secondly, met, the registration standards. The answer was interesting, because although as of 30 November 4,322 domiciliary care providers had applied for registration, only 3,155 of those had been validated and were being processed—which sounds a little vague. Only 243 domiciliary care providers, however, had met the registration standard. That gives rise to the following questions. How many had not met the registration standard? An answer to that would be very useful, and if I do not get one I shall table a parliamentary question immediately after this debate. How many had been approved, but have significant action plans in place? And why is it all taking so long?
	This morning, I rang the commission, but it could not tell me how many domiciliary care providers had failed the assessments. I hope that the Minister has that information at her fingertips when she sums up. I also searched the commission's website to try to establish the date by which all applications must be processed. The search proved fruitless, but when the question was put directly to commission staff, I was told, "There is no date." I am sure that the Government will admit that this endless procedure is completely unacceptable. Can the Minister explain why no date has been set, and what plans there are to rectify the situation?

Stephen Ladyman: Perhaps I can help the hon. Lady with one or two of her questions. The phrase "validated and being processed" means that the forms have been filled in, all the documentation has been received and the matter can be properly investigated; that is different from such people's having been assessed and met the criteria, as she perhaps realises. Frankly, it is a serious problem and at the moment I doubt whether many, if any at all, will meet the standard and be capable of full registration. That is one reason why we introduced the standards and regulations—to drive up the quality of care that such people are providing, and the standards that they are working to—and why we are trying to push them through as rapidly as possible. The hon. Lady and I should be on the same side, fighting the Conservatives, who want to take away all that regulation and checking and return to the old, laissez-faire attitude.

Sandra Gidley: The Minister's answer, although honest, is fairly chilling. He has set great store by this approach. He has admitted that the existing system is failing completely, yet he seems happy to move more and more people into it before the standards are in place. Basically, he has just admitted that an increasing number of old people are being allowed to be subjected to a substandard system. That is totally perverse.
	It would seem that the focus on bed blocking and care home places has taken the Government's eye off the ball. We often denigrate targets in this place, but the Government appear, as we heard in a previous debate, to be inordinately fond of them. Is the lack of domiciliary care targets evidence that the Government are paying only lip service to this aspect of care, or do they know the chosen solution has not been thought through and is ultimately bound to fail if nothing is done?
	People are staying at home longer, but in some cases an individual's care would continue for longer still were it not for the fact that the carer reaches the end of their tether. Written evidence to the Sutherland report highlighted the fact that respite care has emerged as a main priority, and the report itself also admitted that such care is expensive. The way forward would appear to be to extend respite care not necessarily as a right, but by making it available to those most in need. I concur with that, because I regularly come across constituents who are providing care services, but for whom respite is simply unavailable. Where it is available, it is the occasional hard-won week, with no prospect of anything else to come. One elderly carer told me that if she could have a week off every six to eight weeks, she could cope indefinitely. It is the unremitting nature of such care that is affecting her physically and mentally, and in terms of her attitude to her husband.
	Hampshire county council pooh-poohed the idea because of a shortage of beds, but a similar scheme is operating on the Isle of Wight. There are regular respite beds, people are on a rota, the home in question gets to know the patients and the system seems to be working well. It is too early to say how cost-effective it is, but the Government should be looking creatively at such a solution. We need more of these places in order to establish a solution.
	All the evidence shows that these days when people do enter a nursing home—if they can find one locally—their general state of health is worse than it might have been some years ago. I am not saying that that is necessarily a problem if they have been allowed to stay at home, but it does mean that for many, a nursing care assessment is made and the individual is placed into one of three bands of care. That approach was the Government's alternative to that recommended by the royal commission, and it has been fraught with problems from start to finish. The first problem was the delay in getting through all the assessments. Okay, that is history, but it was a fiasco. The second problem was that this period seemed mysteriously to coincide with many nursing home owners putting up their prices. That may well also be history, but we are still stuck with a system that is bureaucratic, inconsistent and often downright unfair. It is not just me that thinks so, and I quote the royal commissioners again. In a recent statement they cited the general inadequacy of nursing care support levels in comparison to nursing home charges. They described the system as "arbitrary and inconsistent", when people with equal nursing needs receive different financial support rates.
	One study showed that in Shropshire 48 per cent. of residents were assessed in the top band whereas in neighbouring Worcestershire it was 12 per cent. That is bad enough, but the overall figures show that the vast majority of patients are placed in the middle band. If that is to continue, it would seem far more sensible to scrap the expense of the assessments—it lies in human resources and high administration costs—and redistribute the money on a flat-rate basis, as in Scotland and Wales. The lack of a proper appeals process is another problem.
	There are still further pitfalls. I make no apology for citing a recent constituency case. When a financial package is worked out, the assessment is usually that the patient will be in the middle band for nursing care. That is a fair assumption because, as we have already said, that is the reality for 90 per cent. of people. However, families often have to decide how much they can really afford to top up and then seek a nursing home that will fit those price criteria. In my neck of the woods, nearly everyone has to top up.
	In my constituent's case, the home did such a good job that her health improved, so by the time that she was assessed, she was in the lowest banding. That meant that her family had to find the difference of £35 a week in home fees, which was impossible because they had already worked out the maximum that they could afford. It also placed the home owner in a difficult position. No other home placement was available in the area and the family was convinced that moving to another home would have made it difficult to visit the mother so often. The mother's health would decline, so she might then be eligible for the middle range of nursing care assistance again. The home owner wrote to me and described the system as providing a perverse disincentive to making sure that a patient's health improved. I am sure that other hon. Members will have similar stories to recount—

Simon Burns: Not if the hon. Lady keeps on talking!

Sandra Gidley: I do not believe that the Government will take any notice.
	The hon. Member for West Chelmsford is being unfair. I have been speaking for a fraction of the time that he was on his feet. [Interruption.]
	I have alluded to the difficulty of finding care places and the motion before us today stresses that aspect of the long-term care system. That is why I have concentrated my efforts on other aspects.
	There are only so many times that the House can be expected to listen to the Laing and Buisson figures, so I shall spare the Minister a repetition of them. However, I query his selective take on those figures. I am pleased that, for once, he admitted that the number of hotspots was causing problems. As he knows, the report states that that is behind the drive to force local authorities to pay higher fees. The Minister may be complacent because he knows that hard-pressed social services departments throughout the land do not pay the going rate because they cannot pay the going rate. In many areas, top-up fees are the norm.
	Rukba, a charity championing independence for older people, highlighted that problem and spent £448,000 in making good the deficit in running its homes. Its assessment is that the funding gap is distorting the balance of supply and demand within the private care sector, and it predicts a major crisis in care provision. It also points out that when care packages are provided, they are retrospective and there is insufficient emphasis on preventing problems. That view is shared by the Association of Directors of Social Services in "All Our Tomorrows", which calls for a broadening approach to prevention and the development of universal services to support it. The Government's approach is far too top-down, and the most recent example is the introduction of a £100 bed-blocking fine, which will be levied—

Simon Burns: The hon. Lady is, I believe, the Liberal Democrat spokesman on long-term care for elderly people. Is she not aware that elderly people and those who live and work in the long-term care sector find the term "bed blocking" deeply offensive?

Sandra Gidley: Yes, the term is deeply offensive—

Simon Burns: Then why use it?

Sandra Gidley: The term is still used by many people to describe a particular situation.

Kali Mountford: Before the hon. Lady moves away from the issue of delayed discharge, is she aware that the Liberal Democrat local authority in my area has said that, to avoid fines, it is best to invest in rehabilitation? That is what that authority is doing, so should she not encourage other authorities to do the same?

Sandra Gidley: I find that slightly confusing. I have said that I think that preventive care and rehabilitation are the goals towards which we should be moving. In some cases, I have no doubt that the money will be spent wisely, but a recent report by Allyson Pollock stated that, if elderly patients were not moved within two days, local authorities might decide to put them in any home rather than in the home of their choice. That would be at odds with the Government's supposed aim of providing choice in health care. It seems that old people will not be allowed to have that choice, and that is a clear case of discrimination.
	If that is the outcome, it would be very disappointing. We will have to wait and see, but there is a growing feeling of disappointment outside the House. A society can be judged by the way in which it treats its old and infirm. At the next election, the Government will be judged accordingly.

David Hinchliffe: I have long been saddened by the cosy consensus between the three major parties in this House that the way forward for the care of the elderly is to shut up more and more people in care homes. Today, for the first time, I heard a Minister challenge that consensus and say that progress lies in another direction. I have been a Member of Parliament for nearly 17 years, and the speech by my hon. Friend the Under-Secretary of State for Health was the best that I have heard any Minister make in a debate on community care.
	I believe in being even-handed in these matters. I shall refer to the Tory motion in some detail, but there is one element with which I agree—its criticism of the Community Care (Delayed Discharges etc.) Act 2003. The Select Committee considered that legislation in some detail. I do not think that it is an appropriate measure, as it addresses the symptoms and not the cause of the problem. If I have time at the end of my contribution, I shall say more about that.
	I think that the Tories have displayed what we in the north of England call brass neck in tabling this motion. The previous Conservative Government created the supposed crisis in care. I want to look at that Government's record in this matter, as the problems that everyone accepts now exist are entirely the result of the policies that the Tories pursued when in office—and that includes the time when the hon. Member for West Chelmsford (Mr. Burns) was a Minister.
	The background to the current position must be examined so that we can understand where we need to go now. The Tories locked us into a hugely expensive, and outdated, institutional model of care, and they did so in a big way. The previous Conservative Government were right to move children out of children's homes and mentally ill people out of long-stay institutions. Why, then, did they do exactly the opposite in respect of elderly people?
	In an intervention earlier, I referred to figures from the House of Commons Library that I received in 1991. They showed that, in the 10 years between 1981 and 1991—when the Tories were in power—this country's elderly population increased by less than 5 per cent. and that the number of NHS elderly care beds fell by 17 per cent., but that the number of private care and nursing home beds rose by 500 per cent. There was a deliberate stimulation of the institutional care sector. Until the Treasury forced the Tory Government to address the Budget implications of that stimulation, the cost came to more than £10 billion. That money was spent on subsidising private care and nursing homes.
	What alternatives to the institutional care sector and to care homes could have been developed with that money? Vast numbers of people who did not need to be there were being sent to care homes without being assessed in any way. The Tories introduced the profit motive into the care of vulnerable and elderly people, and they did so big style. I find that offensive. I find offensive the wholesale privatisation and marketisation that took place under the Thatcher and Major Governments.
	The Tory motion deplores closures, but why do most care homes close? They close for the simple reason that owners know they can make more profit through selling them for something else. The property market has moved in a way that lets them make more money. The whole problem, which the Tories harp on about constantly, relates to their own policy of introducing a market into the care of elderly people.
	I am appalled that the Tory motion has the cheek to criticise regulation of the care home sector. The Tories' record was to draw into the care of elderly people some profoundly unsuitable people motivated solely by the opportunity to make big money. I was shadow Minister for community care between 1992 and 1995. I met people running care homes—a minority, I admit: I am not over-egging the pudding—whom I would not trust to care for a dog, never mind a vulnerable elderly person. Those were the kind of people attracted into the care home market under the Tory Government. I recall speaking at a care homes conference as shadow Minister, and my right hon. Friend the Minister without Portfolio was present. He applauded something that I said, and he was assaulted by one of the people attending the conference. Those are the kind of people whom the Tory Government attracted into the care home market.
	I recall raising in speeches here practices that were being undertaken in care homes. One example that I remember vividly was of 16-year-old youth training scheme students being used to catheterise elderly people in private care homes. That is on the record: it happened in Liverpool. That was the record of the Conservative Government when it came to care of the elderly. The hon. Member for South Suffolk (Mr. Yeo) talked about low politics earlier: low politics is the motion before us, which does not address the quite disgraceful record of the Tory Government on care of the elderly. They resisted—the hon. Member for South Suffolk was responsible for community care—my attempts on several occasions to introduce a Bill regulating domicilliary care to ensure that people who care for folks in their own homes were properly checked on for criminal records and so on. The Tory Government resisted pleas from the social work profession to introduce regulation, but thanks to the present Government we now have the General Social Care Council to ensure that people working with the vulnerable and elderly are properly checked. That is right.
	The Select Committee on Health is currently looking into elder abuse, which is highly relevant to the debate. We were told a couple of weeks ago that 500,000 or more elderly people are being abused in this country at any one time. The question for the Tories on their proposed deregulation is whether it means the repeal of the Care Standards Act 2000, and the scrapping of the Commission for Social Care Inspection, the General Social Care Council and the national service framework for older people. If it does not mean that, what does it mean? Glib comments about deregulation and over-regulation are unacceptable against a background of serious problems with the care of elderly people.
	The Tory motion is clear evidence, as the Minister said, that the Tory party is entirely provider led. It has been hijacked, lock, stock and barrel, by the care home owners. Those owners are writing Tory policy, which is why Tory Back Benchers seem unable to see any possible alternative to care of old people other than sticking them in institutional care.
	I have one or two points on which I hope that the Government will reflect. I have made them before and will continue to make them. At some point, I hope, I will succeed in getting across their merits. First, I make a plea for a more radical longer-term agenda for care of the elderly. In both the Ministers present, particularly the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), we have people who are prepared to listen and who understand the need to move in a very different direction.
	I may be the only person in the House who is attracted to those countries that have got rid of care homes. My long-term objective, as someone who is 55, is that in 20 years, when I may need some form of care, it will not involve sitting wall to wall with and looking at other, similarly demented, gaga people. Frankly, we can do better than that. My mother ended up in that situation, and I swore that I would do all in my power in politics to ensure that we secure a very different future for elderly people. We are slowly but surely improving the quality of that care. We need to get away from the nonsensical outdated models of institutional care that, frankly, belong not in the 20th century, but with the workhouse in the 19th century.
	I want a planned policy of reducing dependence on institutional care with the development of positive alternatives. The Government are moving in the right direction on housing with care and on extra care. We need to follow the model established in other countries, such as Denmark, which have got rid of institutional care. The private, independent and voluntary sectors are gradually going in that direction. The obsession with old people's homes takes us away from the real agenda. Let us get into intensive home care packages and telecare, the type of facilities that we know we can provide to ensure that people remain in their homes.
	I end by making my usual plea that the way forward in the longer term is to merge health and social care within common budgets. If that were to happen, we would not need arrangements for fining social services when people are stuck in hospital beds.

John Horam: I pay respect to the passion with which the hon. Member for Wakefield (Mr. Hinchliffe) stated his case. He is long experienced in the subject, which I have appreciated for many years, and he put his case well, although obviously I disagree about the history of the Conservative party.
	I also disagree with the Minister about the so-called myth that the Conservative party is in the hands of the providers and that it can talk only about nursing homes and residential homes. We all know that our elderly relatives wish to stay in their own homes as long as possible. I have an aunt who is 97. She gave up driving her car only recently, largely because she could not back it into her garage. She was insistent on staying in her home. Only very recently, in the past month or so, did she take the voluntary decision to go into a residential care home because she could not cope any longer. Most people wish to stay in their homes. If that is the Minister's vision, we share it. I have no doubt about that. Keeping people in their own homes is the vision of the hon. Member for Wakefield and my hon. Friend the Member for West Chelmsford (Mr. Burns). There is no disagreement on that.
	I agree with the hon. Member for Wakefield that there are problems across the board. We all accept that there are severe problems. I am privileged to be a parliamentary representative on the Greater London forum for the elderly. We recently held a seminar in the Jubilee Room of the House of Commons. It was attended by a large number of representatives—or at least as many as we could squeeze in—from all over London.
	The Minister may be interested to know that we did not simply discuss home care and care homes; a range of issues was raised. The representatives decided that the issue was the erosion of community care in the London area. We discussed chiropody services, the closure of local pharmacies, domiciliary care, NHS dentists and adaptations. I welcome what the Minister said about adaptations, and the representatives were concerned about how quickly they could be provided and whether people could get what they required. That range of issues forms part of the community care package as it is seen by the elderly. My hon. Friends were right to initiate the debate as an across-the-board issue, not just one that relates to care homes.
	On care homes—we must not be frightened of talking about them just because the Government say that we are in favour of care homes and nothing else—the Minister said there was a huge surplus of places in Kent. That is not the case in Bromley, which is not far from Kent, as he is well aware. The primary care trust recently had to convert beds in the local community hospital into 44 intermediate care beds. I know that intermediate care is only for six weeks, but it did that because of the great difficulty of finding suitable homes for people who were unable to leave hospital as a consequence of the homes and packages not being available to them. So there is a problem.
	The Minister also rightly said—I praise him for this—that he hoped to tour the country, pointing out best practice to local authorities and fixing fees for local care home places. I welcome that, but he must be aware that exhortation from Ministers does not always produce results in the detailed way that he would want. The fact is that there is a marketplace, as he acknowledged, and market solutions are determined by local supply and demand. However much Ministers may wish it otherwise, fair and suitable conclusions are not always reached.
	Furthermore, local authorities use their muscle-power with adverse effects for local care homes. They drive down prices and, as a consequence, individuals who pay for themselves have to pay much more. There is often a difference of several hundred pounds between what a self-payer pays in a care home and the payment for a person whose local authority is funding their care. People who have provided for themselves for their whole life see that local authority support as highly unfair to them. That is one of the factors that has arisen due to the shortage of supply in places such as Bromley.
	Even with the private sector subsidising local authority clients, homes are still closing down, as the Minister acknowledged. They are closing down throughout England but especially in London where the costs and difficulties are greater and where the possibility for making a financial killing is much greater from property development than it is from running a care home. There is no doubt that that is a huge problem in the London area and the Minister must not ignore it. I hope that he will spend some time in London, as well as in the rest of the country, and point out that there are difficulties in the capital, too.
	I hope that we all agree about domiciliary care. However, there is a problem that seems to have escaped the Government's attention. I recently received a letter from a lady in my constituency, which states:
	"I started a small business 2 years ago, providing support services for the elderly, in order to keep them independent in their own homes. This involves shopping, meal preparation, prescription runs and domestic help etc. Quite often, we are the only people our clients see in any week and we become good friends. This year the Government introduced the National Care Standards Commission. Although I comply with all the standards as set, I am not in a position to pay the £2,500 registration fee, nor the £300 for registering each of my staff."
	That lady has a staff of 16.
	I had not realised that the fees for registration with the commission were so high. As the lady cannot afford to register her staff, she has to pay VAT. She serves some of the poorest people in our society, many of whom are on income support, and is competing with larger organisations that do not pay VAT and can make economies of scale. I raised the matter with Age Concern, which replied:
	"The issue of VAT on homecare is one that has been raised a number of times over the years and Age Concern has been very active in trying to ensure that older people who need care services because of their disability do not pay VAT.
	Your enquirer does raise an interesting point . . . We had hoped that the problem of VAT and home care had been resolved but your enquiry makes us realise that there are still some further outstanding issues."
	I have only just received that reply from Age Concern, and I shall write to the Minister about the matter as it affects people in our communities who are most in need and I should like him to address the problem. Although those people receive domiciliary services, some providers have to compete against larger organisations that are VAT-exempt.
	We can all agree about the sort of vision that the Minister outlined, but it is not being delivered. There are many, many problems and the Minister and the Government have still to address them and acknowledge their importance.

Laura Moffatt: It is a pleasure to follow the hon. Member for Orpington (Mr. Horam), who clearly has a great interest in care of the elderly—as I do. When I qualified as a nurse, I decided to concentrate on that specialism and I have always remained interested in the care and treatment of the elderly and in new innovations for older people in our community.
	The hon. Member for Romsey (Sandra Gidley) referred at length to the royal commission on long-term care for the elderly. In 2001, we held a fantastic conference on that issue in Crawley. Many people, especially the families and friends of people who had to remain in hospital, told us that they could not get access to residential care and that there seemed to be a huge problem. I thought that the best way to deal with the matter was to get everybody around a table at the House of Commons and to have a meeting of all the stakeholders, including the care home sector, so that we could discuss things at length and come to a conclusion about why we believed there was a problem.
	Since December 2001 there has been a huge improvement in Crawley, especially in terms of delayed discharges and lack of access to the care home sector. There are many reasons for that. The motion made me cross because it devalued and debased something important by making the spurious assumption that regulation is the main problem for long-term care of the elderly.
	I want to say a little about what is being done in my constituency to give older people the care that they deserve. Of course we cannot yet rest on our laurels, but enormous changes have been made. What struck me when I got everyone together—members of social services departments, GPs, people in the care home sector, housing representatives and many other stakeholders—was that few of those people had met before or had an opportunity to discuss how things could be improved. The crucial element that had galvanised them was Government regulation. It was no longer acceptable for 70 out of 400 beds to be inaccessible because of delayed discharges, for instance.
	We thought that there was a capacity problem in Crawley. We thought that there were difficulties related to funding, housing and a rapidly growing elderly population. When we began to discuss solutions, however, no one mentioned regulation; it was not an issue for all those who were trying to ensure that care of the elderly was the number one priority. What emerged were issues such as improved joint health and social services activity, and that is where improvement has been particularly evident.
	We managed to reduce the 70 delayed discharges to something in the teens, and the number has fallen even more since then. I know that my hon. Friend the Member for Wakefield (Mr. Hinchliffe)—whose work on the Select Committee I respect enormously—is concerned about the Community Care (Delayed Discharges etc.) Act 2003, but I firmly believe that it has provided the extra lever that was necessary to get people round the table to stop the disgrace of patients being stuck in acute settings inappropriately.
	We found that when people met regularly to discuss individual cases, it was possible to get the figures down. What struck us most forcefully was that the capacity issue in the care home sector was, in fact, about inappropriate placement. Everyone seemed to think that because elderly people were not well supported at home—because they were having falls, taking drugs for a long time and not being checked often enough— they could not cope any more. Since then, however, there has been a massive intervention by Crawley primary care trust, which now watches older people much more closely. It ensures that they are checked properly to make sure that they are not being poisoned by the drugs they are taking, and are able to support themselves at home.
	We also found that it was a good idea to use care homes for intermediate and respite care rather than long-term care, and to set aside six beds to prevent older people from having to go into hospital in the first place. That has proved a tremendous success.
	Unlike my hon. Friend the Member for Wakefield, I see a future for the highest-quality residential care; but those who are not prepared to provide such care should not be in business. Therefore, the regulation issues are a complete red herring. If that is making people decide to leave the care home sector, so be it.
	We have an extra problem locally. As the hon. Member for Orpington suggested, land prices are incredibly high, particularly in the south-east, so it is very hard to persuade people, especially those who are getting older and have been in the business for a long time, to continue in the business if they are offered perhaps £1.5 million for a piece of land for redevelopment. So we have a difficulty delivering in that sector, especially in the south-east.
	None the less, with all the new proposals in place, we are making true headway on ensuring that people have proper choice. To walk into the extra care home in Crawley is an absolute delight for me. More than 90 per cent. of the people who went into that home five years ago are still there. That is a testament to having all sorts of care and not concentrating just on the care home sector, but providing real choice and making it available to all the people about whom we care.

Tim Boswell: It is pleasure to follow the hon. Member for Crawley (Laura Moffatt), who sought to introduce an element of balance in the debate on what is an extremely important subject for almost all hon. Members.
	I begin by declaring my wife's interest as a non-remunerated trustee of Brackley cottage hospital, which is a charitable trust and was formerly in the NHS, but now provides services both as a registered home and as an agent for the NHS. Perhaps another debate would be an appropriate occasion to piece together the history of that organisation's attempts to position itself in the right place to deliver intermediate care in the face of constant, serial reorganisation by the NHS. I am now personally involved in a stakeholder group convened by the local PCT to try to find a way forward. I have become very familiar with the situation that the hon. Lady has described in relation to step up, step down, intermediate, terminal and palliative care, as part of the range of provision that may operate and is certainly required.
	I have been most disappointed by the fact that the Minister tried to characterise the debate as one in which the Government say, "We are in favour of the widest possible range of care at home, and the Tories want to see only residential care." I can assure him that that is not our view. In any case, such care is not always appropriate at any given moment. I am thinking of my elderly mother, who died in July at the age of 93. She had to have spells in hospital and spells of respite care. In fact, she died at home, and we were pleased that she was able to be at home when she died.
	There is no simple solution to a complex problem, but I wish to draw on one statistic that came to me as part of the working studies for the local review. It relates to Oxfordshire because Brackley, although part of my constituency, is treated as part of the Oxfordshire health authority for this purpose, as my hon. Friend the Member for Banbury (Tony Baldry), whose constituency neighbours mine, will know. It was reported that 45 per cent. of beds in acute hospitals in the county of Oxfordshire on any one day were inappropriately occupied. I say to the Minister in all seriousness that that shows the extent of the current problem. His intentions to resolve it may be real, but he has not yet been able to discharge that problem.

Chris Mole: Does the hon. Gentleman accept that the number of people going into hospital inappropriately and interventions such as avoiding slips, trips and falls are needed to address delayed care transfers and that they must be considered as much as the output side of the equation?

Tim Boswell: I entirely agree—perhaps we are moving into a more constructive discussion. I tell the Minister that the Laing and Buisson study, the figures that have been cited and all my business experience suggests that if capacity is only 102 per cent. of demand, it is difficult to deliver a proper service. Long-term demographics suggest that the numbers will expand anyway. If we are in a situation, as the Minister conceded, in which some people will require residential care—albeit not for the whole time—or step-up, step-down or intermediate care, there will be a need for residential places, although they might evolve over time.
	However much the Minister tries to explain things away, there is still a strong element of complacency and wishful thinking in the Government's approach. I referred in an intervention to a study carried out by my local community health council—the situation therefore relates to Northamptonshire—that reported that there had been a 25 per cent. reduction in capacity over 30 months, which might reflect several of the pressures that exist. It is difficult to move to an ideal pattern of care if what is available is reduced at such a rate.
	Fining local authorities will do nothing to increase capacity. It was put to me recently that one of the interesting elements of the legislation that could apply is that the number of beds that are defined as finable because they are subject to the analysis for delayed discharge, might be refined down by agreement so that the real coverage of the total number of beds in Northampton general hospital, for example, would not come into the equation and thus there would be further massaging of NHS figures—we are perhaps not unfamiliar with that. The Minister might like to reflect or comment on that.
	The reality of our local situation is that our local authority's fee offer for the provision of care is unlikely to increase by more than 2 to 3 per cent. due to the state of its budget, yet costs in the sector are ratcheting up. It is inadequate for the Government to take no account of the pressures imposed by bureaucracy. One of my local medium-sized care homes that briefed me for the debate referred to the 20 per cent. increase in registration fees, which means that it is likely to pay some £3,000 in registration fees, let alone compliance requirements. Criminal Records Bureau checks will cost it an additional £1,000. It faces many other pressures because although it pays above the minimum wage, its wages will reflect changes to that rate. It also faces other general pressures from the economy.
	It is difficult to envisage even the best care homes keeping in step with the cost pressures that they face, and my experience suggests that it is equally difficult to find immediately available alternatives. I single out for the Minister another local case in which the local authority was unprepared to offer fees at the level that a care home required. The alternative provision suggested was in Wellingborough, but it would not have been fair to move an elderly person some 30 miles because of a row between two public authorities.
	The situation is worrying and it is insufficient for Ministers to say that it is not. It would be more sensible for them to say that they need a palette of different provisions, for things to evolve and to work in partnership with providers, but pretending that there is not a problem to start with will not help. Most of us know how the situation works for our constituents.
	It will be possible to solve the problem if sufficient resources are made available, but the solution is certainly not more bureaucracy. The danger is that the Government's present attitude might evolve in an unplanned way to address the problem. If what we do is insufficient and what is outlined in the press release on the new piece of eye-catching legislation with no substance is not delivered, there will be evolution—or regression—into a two-tier system. Those who can afford to pay the fees required in the market will continue to use the residential sector at high cost, although they will probably erode their capital or become unable to provide an inheritance for their descendents. People who cannot afford such care will simply fail to find a place, because their only recourse is to social services and it will be uneconomic to offer them one. They will end up bouncing back into hospital, at ruinous cost to us all, or into inadequately supported community care. That is light years away from a rational and objective discussion of care requirements which, I hope, we all believe should be our starting point. It is sad that the Government have programmed themselves to fail. I do not believe that they can avoid that, but I would be delighted if they do. The burden is on Conservative Front Benchers to introduce the realistic proposals that we all want on the delivery of appropriate care for elderly people.

Kali Mountford: It would not be right, as has been said many times in our debate, to assert that there are no problems in the system. However, to assert that there is a crisis is going much too far. It not only inflicts stress on people who are in the system, as well as their families and other people who are waiting for care, but skews the debate and stops us taking a sensible view of the situation. However, there have been signs of consensus among Members on both sides of the House, especially on domiciliary care. I was pleased to hear from the hon. Member for Orpington (Mr. Horam) that the Conservative party is not denouncing domiciliary care, as appeared to be the case at the beginning of our debate. I hope that I understood him correctly, because domiciliary care is a valuable part of the package that is required.
	Domiciliary care is one aspect of care where we certainly cannot say that one size fits all. We all know people in their 90s who are still digging their gardens, sweeping their paths and looking after themselves perfectly well. We also know people in their 60s who are in the early stages of Alzheimer's or dementia. The range of care must therefore fit people's circumstances and respond to their problems. We must consider how we got to where we are now, whether the arrangements work, what we learning and where we are going. I do not want to dwell too long on the Tory years, as they do not bear too much examination. However, I remind the House of Ray Griffiths' report on the care sector, which was commissioned by Lady Thatcher. The report appeared after the privatisation of care homes and examined care in the community. It said that the system was chaotic and more planning and investment were required for care in the community.
	The Government are dealing with those requirements. In my own area, people have told me that the measures that we are debating this afternoon were a stimulus for change. All the care in our area has been reviewed and the results have been encouraging, as people believe that the fines for delayed discharges will never apply to them because, in response to the Community Care (Delayed Discharges etc.) Act 2003, they have changed what they do. They invested quite a lot in rehabilitation so that elderly people did not have to go into hospital or, if they did, that there was appropriate care for them on discharge. However, they realised that much more needed to be done and there is now a huge amount of investment enabling that to happen.
	People in my constituency have looked at the range of care that needs to be provided. That is a distinctive feature of the mixed market of care homes, and makes it different from other markets. We must plan that market. We cannot wait for market drift to determine how many homes of a particular type are needed in any one area. We must look ahead and see how many types of provision are required for people with different needs. A pure market model clearly could not work in this sector. I am pleased to hear that that has not been suggested by anyone. Such a model would be mad.
	I would not be happy with any model that excluded any form of help that could be made available. To assume that any model could be taken out, on the assumption that we all want to be in our homes for ever and a day, would be wrong. It would say to people that even if their family felt that they could not support them properly in their own home with the package of care available, people could not make that choice. That would be wrong.
	If the package of care is to be available, it should be properly scrutinised. My own local authority is concerned about the level of scrutiny. It feels not that it is over-regulated, but that the inspections are stringent and sometimes difficult. I have thought carefully about what the local authority says, and I have also looked at the case histories of people who have been to see me. I want to see the evidence for the local authority's view that it is over-inspected. If it is over-inspected, why do I have cases in my surgery where people have had bedsores while they have been in care, where people have not had any stimulation during the day, where they have not received the proper food, or where the water in their water jug has not been changed properly?
	Such things, on a day-to-day basis, month in, month out, can change a person's life significantly. A jug of water may not seem much to us, but to an individual who does not have access to the proper drink during the day, it means an awful lot. It means a lot if someone is given milk when they have a milk allergy and the notes have not been checked. It means a lot if staff have not been trained in the proper use of hoists, when they can be used and when they should not be used, so that a person is left dangling uncomfortably, and in one case left dangling uncomfortably as a punishment, because she had been "a very naughty girl". A patient who is suffering from dementia is not a very naughty girl, but someone who needs the highest standard of care.
	When such cases are reported to me, that tells me that inspections are necessary and should take place ad hoc, without warning. I have heard from people working in homes that they sometimes have quite a lot of notice and they make sure that the place is spick and span. They make sure that all the proper cleaning equipment, which they often cannot be bothered to use, is used on that day. They make sure that the entrance to and egress from the building are clear, which they do not always bother to do as it is a lot of bother to move trolleys.
	I find such features of the system abhorrent. That is not historic information; it comes from people working in the system now. That tells me that we might not yet have the inspection system right, or such things would not happen. We should not loosen the inspection regime. We should work harder and make sure that the standards in our homes are the very best that we can provide.

Tony Baldry: I shall be brief so that my hon. Friend the Member for Castle Point (Bob Spink) can get in.
	Only time will tell whether Professor Pollock's concerns about the Community Care (Delayed Discharges etc.) Act 2003 leading to elderly people being put into inappropriate care come true. My concerns about the Act are different. It creates a blame culture and sets social services against health authorities, when they should be working collaboratively together.
	In Oxfordshire at present there are 55 people subject to delayed transfers. Only four of those come into the statutory category. The other 51 are waiting to be moved to other NHS facilities—by far the most common problem—or there are disputes with relatives about where they should best be placed. It seems daft to set social services against health providers. I agree with the Chairman of the Select Committee. I do not see why we have two separate budgets. We have five primary care trusts in Oxfordshire, a couple of acute NHS trusts and a huge social services department. I do not think that that involves anything about democratic accountability. To be honest, I do not think that any Members of Parliament or county councillors could say with their hands on their hearts that they knew where all the income streams were coming from and going to. If we are going to tackle delayed discharges and ensure that people get appropriate care, why on earth do we not have a simplified single budget and stop the blame culture in which health authorities and social services blame each other for what is happening?

Sandra Gidley: Will the hon. Gentleman give way?

Tony Baldry: No, as I have very little time.
	Next month, to try to get to grips with the problem, rather as Crawley had to do, we in Oxfordshire are having a conference including all the Members of Parliament in the area and county councillors and officials, simply because we need to have everyone in the same room at the same time to discover what on earth is happening. That should not be necessary, and we should have a collaborative approach.
	In addition to those who are delayed transfers in acute hospitals, I understand that there are about 46 delayed transfers in community hospitals. Of course we believe in domiciliary provision, but there is also a need for nursing home and residential care provision. Ministers must accept that that provision is not growing, but contracting. Whatever they say at the Dispatch Box, one of the reasons why it is contracting is over-regulation, and one cannot get away from that. In Oxfordshire, we are not seeing new provision coming forward from the private sector, and the public sector seemingly cannot afford to make it either.
	We have had a lot of Punch and Judy-style debate this afternoon, but I do not think that that helps anyone at all. Can we not try to ensure that more collaborative work is done? I do not think that the Community Care (Delayed Discharges etc.) Act 2003 will help to achieve that aim. I do not think that attacking nursing home proprietors as profiteers, as Labour Members have done, is helpful. Nursing home proprietors whom I have met in my patch are often concerned clinicians who have been doing a lot of detailed work over many years in dealing with patients with serious Alzheimer's and dementia problems. They are not the sort of Dickensian rapacious profiteers that some people have suggested they are. That is a complete caricature.
	I ask the Minister to please see whether we can try to achieve a more collaborative approach. He talked about best practice conferences. I should like to give him an invitation. If he feels that the Oxfordshire health economy or social services are failing in any way, will he please let Oxfordshire Members of Parliament know? Otherwise, can we get away from blame and recognise that all of us have to work together to deal with what will become an increasing problem as we have a larger ageing population, as we will need better care and greater amounts of it? Simply fining or blaming authorities will not miraculously resolve the situation overnight, as the facts clearly demonstrate. We require a collaborative approach, not a confrontational one.

Bob Spink: The long-term care of the elderly is clearly a complicated and very important issue for us all. Many excellent points have been made by colleagues, especially on the Opposition Benches, but also on the Labour Benches. I shall not repeat those points, as I wish to refer to a single example and a specific case study to show how wrong the Minister was to say in his opening remarks that residential care was somehow optional for some people. There is nothing party political in what I am going to say. I shall simply speak honestly for vulnerable people in society, as we must in this place.
	First, I should like to pay tribute to the many care home providers. I congratulate their staff at all levels, including the managers and owners, on their care and dedication in an often difficult area of work. Society is indebted to them and they generally do a most excellent caring job.
	I wish to raise a specific case in order to illustrate a major problem. Mr. Curran is a constituent of mine whom I have visited several times over the past year in Goldenley care home. It is a very well-run home with excellent, dedicated staff and management—a credit to its community. Mr. Curran is a delightful, dignified gentleman for whom I have the greatest respect, and he is singularly fortunate to have a wonderful, caring wife, Doreen, who has fought to ensure that he gets the very best possible care for his medical conditions.
	Sadly, Mr. Curran is very ill—indeed, I have seen him becoming increasingly so over the past six months. He has suffered a number of strokes and the ravages of neuro-degenerative disease. On 17 December 2003, Mrs. Curran wrote to me about her husband's
	"considerable health needs which are:
	Irreversible brain damage due to many strokes
	Epilepsy
	Parkinsonism
	and just recently arthritis has been diagnosed.
	My husband has deteriorated considerably within the last three months and is now mostly in a semi-vegetative state. There is very little response from him now. He cannot communicate; he is unable to move. He is bedridden most of the time. All food, including medication, is now liquid and there is difficulty in feeding as his mouth is rigid and he cannot open his mouth, necessitating the removal of dentures to access his mouth more easily. His body is rigid and he cannot move or straighten his legs. His hands are very swollen and it is impossible for him to move them too."
	She continues:
	"From the outline of my husband's condition you will see that the care he receives is more than social."
	Mrs. Curran believes that her husband should qualify for health care funding for the care on which he so obviously depends for his life. I agree with her when she says, as she did in a further letter to me, also dated 17 December, that
	"it is grossly unfair for my husband to be forced to pay for care in view of the fact that he is such a very sick and disabled man."
	I am pleased to report some recent improvement in Mr. Curran's condition. He is now able to speak a few words—that took place over the Christmas period. I am sure that the whole House will send its very best wishes to Mr. and Mrs. Curran and to everyone at the Goldenley home.
	Having set out the background, let me read out the decision reached by the authorities on the funding of Mr. Curran's medical care. In a letter dated 5 December, the strategic health authority states:
	"As a result of the hearing the Panel reached the conclusion that the Castle Point and Rochford PCT had acted in accordance with the published eligibility criteria of the Strategic Health Authority in that Mr. Curran's needs for nursing and other clinical care are not more than incidental and ancillary to the accommodation provided."
	It seems that the published eligibility criteria of the SHA dictates that Mr. Curran's
	"needs for nursing and other clinical care"
	are "incidental and ancillary" to the accommodation provided. That is perverse and wrong. If the panel's decision was valid, I suggest that the criteria that it used are wrong. I therefore ask the Minister to look into those criteria and to make any changes that are necessary to reflect what should be a civilised society's response to providing medical care for the elderly.
	Home care is not an option for Mr. and Mrs. Curran. He could, of course, be transferred to hospital, where he would get his care completely free of charge, but that would be against his best interests and would reduce his personal quality of life at this time. That would not only be wrong, but against the public interest, because it would be more costly than his residential care home and would block a hospital bed, thereby denying care to other people. The Government clearly need to finesse their policy to prevent that kind of nonsense from taking place and to ensure that appropriate care, and the funding of that care, is provided for people like Mr. Curran, of whom there are many thousands at the moment and will be many more thousands in years to come. I see that the Minister is listening to me carefully, and I thank him for that.
	Will the Minister ensure that private residential care providers are encouraged by fair funding to supply what we expect to be an increasing demand on their services from 2005 onwards? Does the Minister also agree that we must break down the rigid barriers between health and social care and integrate funding streams for the NHS and social services? Above all, we must drop the political correctness in social care and become more person or patient committed.

Tim Loughton: We have had a good debate—a bit of Punch and Judy as my hon. Friend the Member for Banbury (Tony Baldry) put it. I shall endeavour to be the peacekeeping policeman before I hand over to the crocodile of a Minister.
	There is a sense of déjà vu about this debate. Yet again, we are debating long-term care and the crisis in care for the elderly, whether at home or in residential care, about which we have held numerous debates. Each of those debates has been initiatied not by the Government in Government time, but by the Conservatives in Opposition time.
	There were some interesting contributions from Back-Bench Members. The hon. Member for Wakefield (Mr. Hinchliffe) congratulated the Minister excessively on the best speech he had heard in 17 years. It was not the best speech that I had heard from the hon. Gentleman. If anyone has brass neck, it is he, for laying all the blame for the current problems in care at the door of the previous Conservative Government. We were not criticising all regulation but excessive regulation. Frank Ursell, chairman of the Registered Nursing Home Association, said that the regulations make important what is measured, rather than measuring what is important. No one ever died from a small room, but elderly people have died from poor care standards. It does no one a service to rubbish the whole care home sector, as the hon. Gentleman did.

David Hinchliffe: Will the hon. Gentleman give way?

Tim Loughton: No, I want to make progress. The hon. Gentleman suggested that the scandals and misdemeanours of a few in the past represented the whole sector. That is deeply offensive to many people who run good care homes, and to the people who pay good money to stay in them.

David Hinchliffe: On a point of order, Madam Deputy Speaker. I appreciate that the hon. Gentleman will not give way, but I should like to ask your advice about one point. According to the Order Paper, the debate is about the long-term care of elderly people, yet the monitors state that it is about care homes. That is an important point of procedure, and I would welcome your advice, Madam Deputy Speaker, on who is responsible for saying that the debate is about care homes. Perhaps the hon. Gentleman's comments will simply be about care homes, not long-term care for the elderly.

Madam Deputy Speaker: That is not a point of order, although I shall answer the hon. Member's question. The title on the monitor is simply a shorthand version for the terms of the debate.

Tim Loughton: I am surprised that the hon. Gentleman did not blame us for the monitor problem. However, other hon. Members made more measured and positive contributions.
	My hon. Friend the Member for Orpington (Mr. Horam) said that homes were suitable for some people and care at home was suitable for others. The hon. Member for Crawley (Laura Moffatt) made positive comments. I am sure she would have paid tribute to West Sussex social services—an excellent authority—for many of the improvements that they have brought about in the north of the county that we represent. My hon. Friend the Member for Daventry (Mr. Boswell) referred to the use of step-up and step-down roles for care homes. The hon. Member for Colne Valley (Kali Mountford) emphasised that we favour domiciliary care. Of course, most people want to stay in their homes for as long as possible, but that is possible only if we provide the care to support them there. My hon. Friend the Member for Banbury made an important point about the blame culture in the Community Care (Delayed Discharges etc.) Act 2003, which causes so many problems. My hon. Friend the Member for Castle Point (Bob Spink) took up that point.
	There is a crisis, which is not improving. There was a crisis when we raised the loss of 40,000 care home beds; there was a crisis when we raised the loss of 61,000 beds, and there is a crisis now, when we have lost 74,000 care home beds since 1996. There is also the crisis caused by the decline in the number of care home packages for vulnerable elderly people, the increasingly high thresholds that have to be achieved to qualify for them and the potentially counter-productive implications of the newly up-and-running delayed discharges measure.
	My hon. Friend the Member for West Chelmsford (Mr. Burns) has presented all the stark figures concerning the number of lost beds, including the 13,400 lost beds that account for 745 independent homes that have gone out of business in the 15 months to April 2003. Decline continues in new registration for new homes, and hotspots with acute shortages of supply increase. That applies not only to the south-east and the south-west. The problems place greater strain on GPs and the army of 7 million carers who are increasingly exploited by the Government through stealth.
	The demographics over that time are also worsening. I know about demographics; I represent Worthing, where we have some of the oldest people in the country. For the first time, there are now more over-60-year-olds in the country than under-16-year-olds. It is predicted that, by 2015, nearly a quarter of the population will be over 60—an increase of 9 per cent.—and that the number of over-85s, of whom we have the greatest number in Worthing, who need and deserve extra care, will increase from 1.1 million to 1.4 million over that time. Three times as many people over the age of 100 will be living by 2015.
	Throughout all this time, the Government's response has been one of denial, confusion, incompetence and caricature. There have been limited U-turns on the over-prescriptive implementation of care standards acts, climb-downs on Criminal Records Bureau checks, claims of using lighter-touch regulation, and a rubbishing of care homes across the board as "banging up" elderly people, as the former Secretary of State put it. Today we have again heard the Minister claim that there is no national crisis in the care sector. He is the "Crisis? What crisis?" Minister, and he spent 33 minutes today rubbishing the care home sector and accusing it of peddling myths, yet he was perfectly happy to quote a report from Christie's—of all people—about what was going on in the care home sector. He also made a disgraceful criticism of the British Medical Journal for being sloppy in some of its reporting of this matter.
	We have heard some interesting innovations, including the claim that the Community Care (Delayed Discharges etc.) Act 2003 was actually a money-spinner for local authorities, and a profit-making exercise. Is this a new turn in Government policy? Are we now going to see an early discharge of pupils Bill to introduce truancy fines, so that education departments can benefit from truancy? Perhaps we could have a Bill to introduce fines on late-running buses to fund local authority transport. This is fantasy island in the extreme. Ministers may come and go, but this problem is set to stay and to get worse. It affects some of the most vulnerable people in our community, and they are being failed by the Government.
	The Minister complacently states that we must accept that the sector is contracting, and that that process will go on. He justifies that by saying that more people want to live in their own homes for longer. I am sure that that is right, but this is a matter of horses for courses, and what is needed is real choice: available, quality, serviceable choice. Of course staying at home is an ideal, but only if people are given the support to do so. We are increasingly seeing elderly people living at home, growing older and frailer, while the level of their care package diminishes or, in some cases, is withdrawn altogether. In some cases, there is no package available in the first place. Living at home is not a real choice if a person's quality of life diminishes unreasonably by doing so.
	There is an added problem of the shortage—particularly in the south-east of England—of skilled social workers, leading to the greater use of agency staff to service home care packages, often changing quickly and going in and out of homes quickly without building up a relationship with the clients they are looking after. If the clients cannot cope, they then become emergency readmissions to hospital, of which we have seen an enormous increase in numbers. As the Royal United Kingdom Beneficent Association put it, people need independence without isolation in order to have a real choice about remaining at home. That is not happening, despite the best endeavours of social services departments, which are facing a crisis in funding.
	Despite all the Minister's bluster, the vast majority of increases to local authorities have been passported to education. West Sussex, my local authority, has left just £400,000 to service social services, transport, highways, the environment and all the other services. We also got another £6,000 recently thanks to the generosity of the Chancellor. This is in a county in which the formula grant per head gives £503 to my constituents, compared with £810 per head in an outer-London borough. It is also in a county in which social services budgets are being stretched between elderly care, child protection and the implications of the Laming report and the forthcoming Children's Bill; these all constitute demands on a dwindling budget.
	The pips have long since given up squeaking, and it is the elderly and vulnerable people who are being squeezed the most, whether in three-star, two-star or no-star authorities. This is a double whammy, because increasingly frustrated and abused care home managers are being over-regulated, under-recompensed, generally put upon and abused constantly by the Minister and his colleagues. As one care home owner put it recently,
	"Everyone is running my business except me."
	There is little correlation between the quality of care in a home and the level of inspections and the hoops that it is put through. One doctor who was recently inspected by the National Care Standards Commission said,
	"I am perfectly happy to be assessed, provided that I feel we are working on the same side, trying to improve the care of patients."
	Far from pursuing a policy of being on the side of those looking after care of the elderly, however, the Government have set themselves on a course of confrontation and bullying with their response in the Community Care (Delayed Discharges Etc.) Act 2003. They are robbing Peter to pay Paul—the antithesis of partnership—undermining years of good work on bringing social services and health care closer together in the interests of patients. Because of the delayed discharges Act, if a patient's first choice of care home is not available, older patients will be offered an interim placement that may be far away from their families and not necessarily appropriate to their care needs. Allyson Pollock, who has been much quoted this evening, has said that that contradicts the Government's pledge to "give genuine individual choices" and that this legislation
	"is targeting really vulnerable people and placing them at greater risk."
	As with so much in new Labour's health service, far too many of the vulnerable among our communities' sick and elderly people are paying the price of a system dominated by bureaucrats not patients. We make no apology for raising this issue again. We do so not as a mouthpiece for care home owners but as a mouthpiece for many elderly constituents who are suffering from the Government's squeeze on social services departments and their obsession with constantly rubbishing care home owners and treating decent care homes on a par with the Lubyanka from whose clutches people must be saved at all costs. That is why we need this debate today. I urge all Members living in the real world, who recognise the problems that we have set out today, to support the motion in the interests of their elderly constituents before they join their ranks.

Rosie Winterton: As the hon. Member for East Worthing and Shoreham (Tim Loughton) said, this has been a good debate. As the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman) said in his opening remarks, however, the Opposition, in calling the debate, have started from completely the wrong assumption. As ever, they are living in the past. They assume that the way in which services to old people have been delivered previously is exactly the way in which they should be delivered in the future. That is not what older people want. What older people want and need is a Government who are committed to increasing standards in all sectors for older people, and who are committed to making independence and choice for older people a reality.
	That policy has not come out of thin air. This Government have consulted widely with older people and their representatives, and we know from our consultation—from hard evidence—that as people get older they still have the same aspirations. The vast majority want to stay in their own homes and neighbourhoods as long as possible, and our policy delivers that.
	Let us be clear about the track record of the Conservative party. Under the previous Tory Government, funding to councils for social services rose by just 0.1 per cent. per year between 1992 and 1997. This Government have changed that. We have given councils a real terms increase of 20 per cent. over the last six years, and on average a further 6 per cent. real terms increase this year and until 2006. When the Conservative party left office in 1997, funding of social services was £7 billion. By 2006, that will have increased to £15 billion—a massive investment in services for older people.
	What Labour Members found most shocking, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, was the attitude taken by those on the Opposition Front Bench towards regulation. Thinking about it, however, perhaps we should not be surprised. They opposed the protection given by the national minimum wage, and they opposed the protection of people at work. Now they are opposing the protection of some of the most vulnerable people in our society. We completely reject their attitude towards regulation.
	The speeches from the Opposition Front Bench were in contrast to the rather more thoughtful speeches by the hon. Members for Orpington (Mr. Horam), for Daventry (Mr. Boswell) and for Castle Point (Bob Spink). The hon. Members for Castle Point and for Orpington both raised issues about which they intend to write to my hon. Friend the Under-Secretary, and he has undertaken to examine those issues. I can also assure the hon. Member for Daventry that we will not be massaging figures in the way that he described.
	The hon. Member for Romsey (Sandra Gidley) referred to the royal commission and to free personal care. I should point out that we accepted every single one of the commission's recommendations, but we stressed in our response that personal care for everyone would not in itself guarantee service improvements. We could spend on free personal care the additional £1 billion that we are making available annually for improvements in service delivery, but we do not believe that that is the best use of finite resources. As was pointed out, seven out of 10 older care home residents already have some or all of their personal care costs paid by their local council.
	My hon. Friend the Member for Wakefield made an excellent contribution; I say that not only because of his very perceptive comments about my hon. Friend the Member for South Thanet, but because of his devastating critique of the record of the previous Tory Government. I also congratulate my hon. Friends the Members for Crawley (Laura Moffatt) and for Colne Valley (Kali Mountford) on their contributions. They spoke very eloquently about the need for integration of health and social services, and about rehabilitation services. They showed that the fears that the hon. Member for Banbury (Tony Baldry) expressed about delayed discharges were misplaced.
	The motion before the House is stuck in a view of the past that does not correspond one iota to what older people tell us they want, or, indeed, to what younger people want to look forward to in older age. It is true that each generation expresses higher expectations. We expect an improved standard of living, more choice and better services; that is as true whether one is 35, 55 or 75. That means that we as a Government have to change and to expand the models of care to meet those aspirations.
	This Government reject the concept of a model of care that creates dependency and is too often of low quality. We want high quality care that offers choice and independence. Meeting aspirations inevitably means changing services, and we fully recognise that change can be difficult. But what we have done is to set up a properly regulated system, so that councils and primary care trusts can work with providers to deliver high quality services to older people that meet local needs and reflect local circumstances. That is what local accountability and local democracy are all about.
	Let me remind the House of some of what we have done to make such choice a practical reality. We have set up an £87 million fund for extra care housing. We have made community equipment and intermediate care available free to the individual. We have provided £170 million to enable more people to live at home. And we have committed £70 million to support training for social care staff, many of whom work with older people.
	After years of stagnation and underinvestment under the previous Administration, change is challenging to those delivering services for older people. It is challenging to partnerships, and to those who want to keep on doing what they have always done, in the same way that they have always done it. It is challenging to poor standards of care and to limitations on choice. But the challenge is right and proper, and the Opposition motion does a disservice to older people by continuing to look backwards, rather than seeing the opportunities for the future. As ever, the Opposition have the wrong approach. They want to restrict choice to those who can pay, and to offer nothing to the majority. We believe in giving everyone choice.

Question put, That the original words stand part of the Question:—
	The House divided: Ayes 200, Noes 334.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Madam Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House welcomes the real terms increase in social services funding of 20 per cent. between 1997 and 2003, and the commitment to continue these increases by an annual 6 per cent. in real terms from this financial year to 2005–06; notes that councils are able to use these resources to increase fees they pay to care homes where they think necessary, with 2002–03 figures showing 56 per cent. of local councils in England and Wales increasing the fees they pay by at least 5 per cent; notes that the Laing & Buisson Care of Elderly People Market Survey published in July 2003 puts bed capacity in care homes from all sectors at 470,000 with demand estimated to be around 460,000; further notes that over 80 per cent. of older people say they want to live independently in their own homes for as long as possible; supports the Government's policy of improving choice by providing alternatives to residential care with 20,900 more households since 1998 receiving intensive home care packages, 143,200 additional people receiving intermediate care services since 1999, and a cash injection of £87 million to be spent on creating 1,500 new extra care housing places by 2006; and further supports the Government's policy of driving up care standards where the care is delivered and ensuring that older people are not held unnecessarily in acute hospital beds when their care needs can be better met elsewhere.

REGIONAL BROADCASTING

Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]

John Denham: I am extremely grateful for the opportunity to raise concerns about the decision by Granada-Carlton, the new single ITV, to run down Meridian television, which is based in Northam in my constituency. With your permission, Madam Deputy Speaker, I shall try to allow other hon. Members to contribute to the debate.
	Before Christmas, Meridian announced 175 job losses. Its plans include the closure of the Northam studios and relocation to Fareham, the closure of the Maidstone studio, the winding up of the successful teams, which covered, for example, the recent rugby World cup and ocean racing, and a major restructuring of the most successful of the regional ITV news services.
	In part, I want to express local but important constituency concerns, but I also want to raise the implications of what Meridian is doing for the entire new ITV. The managing director of Meridian said that its plans are a blueprint for the rest of the new single ITV. If so, my right hon. Friend the Minister needs to recognise that there are major implications for regional independent television and serious challenges from the outset for Ofcom and the new regulatory regime.
	The contrast between the promises made to Meridian staff at the time of its take over by Granada and what is happening now should make everyone who is concerned about ITV cautious about relying on promises or assurances that its management might give. I hope that the Minister will note that, too. Of course some change is inevitable, especially in a highly technology-dependent and sensitive business. I understand that there is probably no real business case for large outdated studios of the sort at Northam in Southampton, but, although change is inevitable, that does not mean that we should not consider what is proposed carefully.
	I pay tribute to all the people who have worked at Northam over the years, not just under Meridian, but under TVS and Southern Television too, and who created programmes that will be familiar to hon. Members, such as "How?", "Worzel Gummidge", "Out of Town", the "Ruth Rendell Mysteries", "Village Voices", "Spotlight", "That's Life" and many other programmes, both regional and national, including sport, most recently the World cup.
	Southampton as a city has gained enormously in profile and prestige from being the main home for both BBC South and ITV for a long time. In the 1980s, the then Labour council fought a hard battle to keep BBC Television in Southampton, for which we have been well rewarded. It is a shame that the new Liberal Democrat council, despite its efforts, has not been more successful in keeping Meridian in the city.
	The south-east does not have a simple, clear regional identity, such as the south-west or the north-east, but neither are we a glorified suburb of London. The south-east has the most successful regional economy. We have distinct counties, sub-regions and communities. We have our own sporting, cultural and artistic traditions. We have unique cities, towns, villages, countryside and coastal areas.
	The south-east should be reflected to its residents, to the country as a whole and to the wider world through good regional broadcasting.

Bob Spink: Is the right hon. Gentleman aware that the region also includes people in my constituency in south Essex and in the constituency of the hon. Member for Thurrock (Andrew Mackinlay), who is in the Chamber nodding in agreement that our constituents would be impoverished by the proposals and that we should do everything we can to retain those facilities in Southampton?

John Denham: I am grateful to the hon. Gentleman for that intervention. People watching these proceedings on television may realise that there are far more hon. Members on both sides of the House than is normally the case for the end-of-sitting Adjournment debate. I hope that my right hon. Friend the Minister will recognise the concern that is being expressed in the Chamber.
	In the south-east, we also want our fair share—or, to be frank, a larger share if possible—of television production and its related creative industries in our region. The past two years and the current proposals suggest that responsibility for regional broadcasting is about to pass almost entirely to the BBC. First, there was the national deal with the Independent Television Commission, which cut regional programme slots from 15 to eight and a half hours a week—much of that can hardly be described as regional programming. Not long ago, budgets at Meridian were cut from between £20,000 and £25,000 for a half-hour slot to between £5,000 and £12,000 and I understand that the figure may fall further. Now, we learn that half the staff at Meridian are to go.
	What a contrast to the promises made by Charles Allen, then chairman of Granada, and Steve Morrison, its managing director, when they took over the company. I have been given what I believe are genuine and reliable transcripts of their presentation to staff. Mr. Allen, currently head of the new ITV, said:
	"The first thing is that we are absolutely passionate about regionalism. Regionalism is absolutely the heart of everything we do . . . we didn't spend £1.75 billion not to grow this business. You don't buy a company of this scale with this level of talent not to listen to them"—
	the staff—
	"you are now part of a much bigger operation . . . where particularly production plays a key part".
	Mr. Morrison told staff:
	"And to echo what Charles said, we are not in the business of contraction, we are in the business of expansion. What we want to see is more production more play coming from this studio site and indeed, you know, your other satellites than you already do . . . You've developed over the years a capability in certain types of programmes. And, you know, nationally important programmes, like your Dispatches are well recognised. And the issue for us is how do you build that up."
	"Absolutely passionate about regionalism", "the business of expansion", "more production coming from this and our other sites": what a contrast with the closure and contraction currently facing Meridian. It is not surprising that many people working for Meridian feel badly let down.
	I know that Ministers cannot be responsible for what business executives tell their staff during company takeovers. However, the issue is not just the development of any old private business; it relates directly to the future of Channel 3, to the public service broadcasting obligations of ITV and to the development of one of the UK's major industries—television production. Those should be of concern to my right hon. Friend the Minister and I hope that she will take note that it would be dangerous to rely too much on the promises and assurances that might be given to her and others by the people now running ITV. Meridian staff did just that, and look what is happening to them.
	The truth is that the drive for a narrow interpretation of shareholder value in ITV is leading to the same short-term drive to maximise profit at the expense of the long-term investment in and development of the business as has been seen in other major companies in the US and the UK over the past few years. Even the much-vaunted new investment in the new studio looks likely to cost less than the money that will be made by selling the Northam site. I believe that one of the consequences will be a sharp decline in Meridian's ability to make regional programmes—whether we are talking about programmes about the region for the region, programmes about the region for the network, or the ability to make a wide range of programmes designed specifically for the network.
	Indeed, I fear that the impact may well be wider than Meridian itself. Of course, national or international sports coverage, a particular area of expertise in the Meridian company in Southampton, need not be based in Southampton or any other specific UK location; but the concentration of media skills in regional centres sustains the whole industry in that area. It is the pool of talent that supports independent programme-makers and the BBC, works with academic institutions and assists new local broadcasters.
	Let me say in fairness that I know Meridian does not intend—or says it does not intend—to turn its back on all those links, and wants to develop new links. Nevertheless, I believe that a sharp reduction in television employment such as the one that is proposed, and the loss of skills that that will involve, is bound to have a wider impact on the health of the television industry in the south. We have been told that Meridian is the model for the rest of the new ITV. If that is so, it means stripping out serious regional programme-making in ITV and also encouraging a decline in the strength of the regional television industry as a whole.
	I am also concerned about news coverage. It may well be possible, with new technology, to organise and deliver news coverage more efficiently and effectively than is the case at present, but it is pretty clear that the current proposals are driven primarily by a wish to cut costs rather than by an analysis of the best ways—including the most efficient ways—of delivering a news service in the future.
	Meridian is unusually successful as an independent television news service. Maidstone has regularly achieved ratings as high as 50 per cent., while Granada usually achieves about 12 per cent. The outlets in Southampton and Newbury regularly secure about 30 per cent.—much more than many other ITV regional news programmes. I would say at the very least that altering the current arrangements, which are so successful, without really good justification based on an analysis of the best way of serving the public rather than an analysis of the best way of saving money, is a strange way of going about things.
	I have not been able to confirm this, but I have been told that the original announcement of job losses was not covered by Meridian's regional news. That is surely unusual; would it have happened if any other company was to lose 175 jobs?
	Moreover, is the regional political coverage that Members of Parliament enjoy safe? It is easy to understand that a single ITV company might want to save money on its political coverage, but I suggest that that would be at the expense of the local knowledge that makes regional news and regional political coverage worth having.
	These changes are happening just as the new regulator, Ofcom, comes into existence. I shall end by raising some issues that should be of direct concern to the Minister: that constitutes an invitation to Members who may wish to intervene. Let me say that, as the Government move towards statutory consultation rights for UK employees, I hope the Minister shares my distaste for the way in which Granada apparently went off to the ITC to secure support for its proposals before informing any of its staff.

Mike Hancock: I agree that Ministers cannot be responsible for what Meridian told its staff, but surely they are responsible for what Meridian told its viewers about the retention and building up of a regional dimension in its programming. That is manifestly lacking in the proposals as we see them.

John Denham: The hon. Gentleman raises an important issue relating to, in particular, the new role of the new regulator. It brings me to my second point: the changes are taking place before Ofcom has decided how to interpret its requirements for regional production quotas and expenditure outside the M25. Ofcom recently wrote to me
	"We will be considering how this requirement will be interpreted and are establishing arrangements to gather the necessary data for ITV to demonstrate that there is a reasonable geographic spread in the sourcing of network programmes."
	That requirement was a key element of the Communications Act 2003. It seems that, by presenting a fait accompli at Meridian, the new ITV will effectively set its own baseline for Ofcom and reduce Ofcom's scope to set a challenging interpretation of those regulations.
	I should be grateful if my right hon. Friend the Minister would respond directly on whether the reduction in Meridian's programme-making capacity can be held back until Ofcom has decided how to approach the issue. If that can be done, will she use every power that she has, either legally or by persuasion, to ask for that to be done? At the very least, it would be much better if the issue were looked at when those at Ofcom have got their feet under the table and have worked out how to approach the issue, which would ensure that it is considered properly.

Norman Baker: The right hon. Gentleman is making a very good case. Does he agree that the transmission of local news for Sussex and Kent from a base in Hampshire, following the closure of any Maidstone outlet, will be detrimental to people in Sussex and Kent and that such news cannot possibly be of the same quality? More importantly, is this not the thin end of the wedge? If Granada gets away with that closure strategy without intervention from Ofcom or the Government, it will be repeated throughout the country.

John Denham: We have already been promised that what is being done in Meridian is the model for the whole of the rest of the ITV network. That is what we seem to have been told, and those are the risks. As I said earlier, I can accept that there may be different, better and less expensive ways to organise the way in which news is delivered, but I am pretty clear that these proposals have been driven by a desire not to improve, but to cut the cost of the news service, so my hon. Friend is right, as I hope that other hon. Members and I are, to express those concerns about the risks that are involved.
	A couple of colleagues wish to speak briefly in their own right, so I will conclude my remarks. I hope that everyone will recognise how many hon. Members have attended the debate. This is a matter of great concern. Unusually, while it is a big issue for my constituency, this Adjournment debate is of national significance. What happens in the south-east will have repercussions throughout the United Kingdom, and the fact that hon. Members from Northern Ireland and Scotland are present reflects that interest.

Derek Wyatt: I congratulate my right hon. Friend the Member for Southampton, Itchen (Mr. Denham) on putting such a strong case, and I associate myself with all that he has said.
	I raised this issue first with the Select Committee on Culture, Media and Sport, and our report will be out shortly. Although I cannot say whether this will definitely be in the report, there is one thing that we will ask: will Ofcom please handle the issue in the open? In other words, when it takes evidence from Meridian, the National Union of Journalists chapels and other people, will it do so in the public domain, not behind closed doors? That is something about which the Minister might have a view.
	In the 1960s, a famous chairman of Anglia Television—once a very great company—said that ITV was a licence to print money, and it wants to get back to exactly that. The Carlton merger will benefit senior management, not the viewers. I am told that two things were on the agenda at a recent senior management away day—one was something about communicating the changes and the other was to ramp up the share price.
	Let me deal with the communications bit. The first thing is that there was a leak, which shows how good that management is. There was no communication with the staff, the workers, the producers or anyone. The proposal came out of the blue, from left field. Those involved are running to catch up, which is what happens. Secondly, I ought to congratulate not just my constituents who raised the issue with me, but the NUJ chapel at Maidstone, which has been absolutely fantastic. I congratulate the chapel on its efforts.
	Why would anyone want to reduce the service to ramp up the share price? People would only want to do that for two reasons: first, to reward senior management and, secondly, to make the company attractive to a buyer. They are the only two reasons, and they do not serve the population and the viewers. I am a moderniser and I understand modernisation issues, but once Maidstone has been stripped out, the local journalists will be stripped out, even those with cars, laptops and digital cameras. Within three years, if the company has not been sold already, the political correspondents will be stripped out. Look at what has happened with the political correspondents in Parliament. In fact, there will be no local service, no local knowledge—no local anything—and certainly nothing regional. That is what the company wants to happen.
	ITV2 could have been the regional option for ITV, but it is not. ITV2 has a budget of just £1 million for original programming. The situation is crazy and a disaster because there was a chance to use the channel for regional programmes. I hope that the Minister will be persuaded that the BBC charter review could give a regional channel, as part of the public sector service review, to take the place of ITV. The situation is appalling, so I am grateful for the few minutes that I have had to make my case.

Jonathan R Shaw: I, too, congratulate my right hon. Friend the Member for Southampton, Itchen (Mr. Denham) on securing this important debate. The Meridian studios in Maidstone are located in my constituency and "Meridian Tonight", which covers both Kent and Sussex, has the highest ratings of any regional news programme in the country. My right hon. Friend cited a ratings figure of 50 per cent. Meridian has reached that figure and is talking about improving on that record, which I hope it does. However, for the reasons set out by my right hon. Friend, many of us have a jaundiced view about whether the figure will be breached. Many ITV companies throughout the country would look enviously on the successful regional news programme's record and we should not forget the advertising revenue that it brings to the company. The BBC recently moved its south-east operation from London to set up a dedicated news programme covering Kent and Sussex in response to Meridian's lion's share of the audience viewing figures.
	Although Meridian's studios are in my constituency, we are not wedded to buildings and there is not necessarily a question of whether the building will remain. However, the location and quality of the staff who produce such an excellent programme cannot be dismissed because that infrastructure has been built up over many years.
	We are greatly concerned about the mixed messages that have come from Meridian. Mr. Clive Jones, its managing director, recently told the Select Committee on Culture, Media and Sport:
	"We are not proposing to diminish the number of journalists at all. All we are talking about is moving a presenter and maybe a technical director. The journalists will stay . . . the reporters will stay".
	Tim Suter of Ofcom said a similar thing in response to a representative of the National Union of Journalists. He said:
	"Colleagues here and in the south region have been given detailed information that the reporting staff in the South-East will remain at its present strength, as will the camera teams."
	In reality, however, both presenters will be based in Hampshire. The sports presenters will be based in Hampshire, so there will be no one in Kent or Sussex to cover sport, and the sports job in Maidstone is being axed. Only two out of seven production journalists will remain in Kent, the size of the news desk will be reduced from three people to one and one reporter's job will be lost. Perhaps it is not surprising that today's edition of The Guardian says that the head of ITV news is considering quitting. Ofcom must take a robust line, as the Prime Minister said to me a couple of months ago when the proposals came out. We want a robust response from the Minister.

Estelle Morris: I apologise for the fact that I have only eight minutes in which to reply, but I wanted to give hon. Members as much time as possible to speak on what I know is an important regional issue. Every Member of Parliament understands the importance of regional media coverage. Indeed, I understood that importance better as an MP than as someone who was not especially actively involved in politics. I know that many issues that we raise on behalf of our constituents would never get back to them if it were not for regional broadcasting and journalism. Our constituents, as citizens, have the right to have their concerns raised here, so we need a channel of communication between this place and their homes to ensure that they know that we are acting on their behalf. I understand the anger that I sense and—without prejudging the issue—the feeling among hon. Members that they have been let down. It is for Meridian and hon. Members to talk about that, but I understand the strength of feeling and know what an important local issue we are debating. The irony, as my right hon. Friend the Member for Southampton, Itchen (Mr. Denham) said, is that, having set up a framework and given the regulators the power to act, there is very little that the Government can do at this time. I therefore want to make a robust response, as hon. Members asked me to do, and make a few observations.
	It does not matter whether it is Meridian or any other employer, it makes good sense and is good management to let people know that their jobs are at risk before telling the outside world. It is only humane to treat individuals in that way, and if that did not happen in this case, that is regrettable.

John Redwood: rose—

Estelle Morris: I will give way on this occasion, but shall not do so again, as I have very little time.

John Redwood: I am grateful to the Minister, as I did not get the chance to make a speech. Is she happy with the autopilot system set up by the Competition Commission and Ofcom, given the tragedy that is unfolding?

Estelle Morris: Yes, I am. However, this may be a test case, and I expect Ofcom to act strongly, as I shall explain.
	The Communications Act 2003 has given extra protection to regional broadcasters. There is a framework of licences for regional programming and production, and the test will be whether Ofcom, the regulatory body, acts firmly if the terms of those licences are not adhered to. Having listened to right hon. and hon. Members, I believe that there are two particularly important issues. It is not appropriate for me to comment on one of them because the time to do so has passed. As my right hon. Friend the Member for Southampton, Itchen said, the target or quota for programming used to be higher. There is now a quota of eight and a half hours for regional programming, and there is also a quota for sub-regional news coverage. Ofcom must ensure that those targets are adhered to, but it cannot intervene in respect of a quota that has been changed by agreement with the Independent Television Commission from 15 hours to eight hours. We have set a lot of store by Ofcom's regulations, but the time to comment on them has passed. Whether they are right or wrong, good or bad, and whether the ITC could have come to a different agreement, the time for comment has passed. However, the licence clearly says that Meridian has undertaken to produce eight and half hours of regional programmes, five and a half hours of which must be sub-regional news and three hours non-news. Ninety per cent. of those programmes must be made in the region, because that is one of the quotas in the framework.
	Ofcom is considering representations that it has received. If it is thought necessary, it could act to make sure that Meridian keeps to the terms of its licence. The bottom line is that those quotas or targets are in Meridian's licence, and I expect Ofcom to act to make sure that they are preserved. Members from all political parties must surely agree about that. The Government are trying to pull off the trick of giving companies flexibility and freedom to meet the competitive challenges that they face, to make changes to adapt to new technology and digital broadcasting, and to reorganise personnel as times change. Nobody wants things to stand still. My right hon. Friend generously said that Meridian, like any other company needs, from time to time, to make changes. As a media business, it needs to act quickly. No one wants to go back to the days when, to make change to, for example, patterns of employment, companies had to seek permission and jump a series of hurdles imposed by the ITC, Ofcom and the Government. Nobody wants to let that happen again.
	There is clearly a deal to be struck. If companies are to have the freedom that they need and want, we must make sure that Ofcom is empowered to act ferociously if they break the terms of their licence. This is a test case. The time to discuss whether the terms of the licence are sufficient to protect regional broadcasting has passed, but my robust message to the House is that I expect Ofcom to monitor the terms of licences and to take action if they are broken. I apologise for not answering all the questions asked by hon. Members, but I accept the importance of this debate. I can assure them that the Government will monitor what happens as far as possible. If things do not go as expected, we will have reason to comment in future.
	Question put and agreed to.
	Adjourned accordingly at fifteen minutes to Eight o'clock.